Health First Colorado and CHP+ Provider Revalidation
Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid Program) providers must revalidate in the program at least every five (5) years to continue as a provider. Organization Health Care Providers are required to obtain and use a unique National Provider Identifier (NPI) for each service location and provider type enrolled.
- Provider Revalidation Manual
- Revalidation/NPI Law Fact Sheet
- Revalidation Quick Guide
- Provider Revalidation Dates Spreadsheet (updated 01/18/2021)
- Revalidation Information by Provider Type
- Revalidation Information for HCBS Providers
ATTENTION: The deadlines for the next revalidation cycle will be in October 2020, based on previous enrollment approval dates. Providers will be contacted via email approximately 6 months prior to their revalidation deadline with further instructions. Attempting to revalidate by completing a new application before being notified will create duplicate enrollments and cause claim processing issues.
- What can providers do now to prepare?
- Ensure each National Provider Identifier (NPI) for Health First Colorado is also enrolled with Medicare, for providers who bill Medicare. Please see the Colorado NPI Law web page for more information.
- Obtain a new NPI prior to revalidating, if needed. House Bill 18-1282 requires newly enrolling and currently enrolled organization healthcare providers (not individuals) to obtain and use a unique NPI for each service location and provider type enrolled in the Colorado interChange. Visit the Colorado NPI Law web page for more information.
- Ensure all data and contact information in each enrollment profile is correct prior to revalidation. For specific information for billing groups and rendering providers, refer to the Special Revalidation Newsletter III. If the Web Portal log-in credentials need to be reset in order for the provider to access it, contact the Provider Services Call Center at 1-844-235-2387. For step-by-step instructions on updating provider affiliations and contact information, refer to the Provider Maintenance - Provider Web Portal Quick Guide, available on the Quick Guides web page.
- It is important to ensure that employees who have left a provider group no longer have Provider Web Portal access for information such as revalidation, claims, eligibility and banking updates. Providers must set the status to inactive for any delegates no longer in the group by logging into the Web Portal, clicking on Manage Accounts, and clicking the Add New Delegate/Office Staff tab. Refer to the Delegates Provider Web Portal Quick Guide, located on the Quick Guides web page, for more information.
- What do providers need to know?
- Review the Revalidation Resources and Revalidation Newsletters for more information on the revalidation process.
- Refer to the Revalidation Quick Guide now available on the Quick Guides web page for more information on completing the revalidation application through the Provider Web Portal.
- Providers will be revalidated on a continuous, rolling 5-year schedule.
- Providers with multiple locations will not have to revalidate all sites at once unless all the locations were approved on the same day. Email notices will be sent separately for each location.
- Each provider will be notified via email six months in advance of their revalidation deadline. The deadline is based on the date the enrollment application was approved.
What information can be updated through revalidation?
Some information will be auto-populated on the revalidation application, so not all sections are required to be completed. Providers should verify all the data in the provider’s enrollment profile is correct and up-to-date prior to revalidation.
The table below displays what information can be updated through the revalidation application versus what content can be updated through a Provider Maintenance request separately in the Provider Web Portal.
|Provider Web Portal Panel||Panel Sections||Revalidation Application||Provider Maintenance Update|
|Request Information||Initial Enrollment Information|
|Provider Information||✔ (NPI only)|
|Billing & Mailing Address||✔||✔|
|Provider Identification||Provider Legal name||✔|
|Durable Medical Equipment Information||✔|
|Identification Types Not Listed in Revalidation||✔|
|Other Information||Malpractice/General Liability Insurance, certification||✔||✔|
|Additional Information Section (Website)||✔ (Additions only)||✔ (Additions or deletions)|
|Fingerprinting||Fingerprinting and Criminal Background Check||✔|
|Attachments and Fees||Attachments (Supporting Documentation) and Fees||✔||✔|
|Agreement||Provider Participation Agreement||✔|
*The Provider Maintenance Update column is not a conclusive list of all items that can be updated through a Provider Maintenance request.