Revalidation

  

 

Providers are reminded that they must enroll every location for facilities, groups, and Atypical, but not for individual.

ATTENTION: Providers will be notified via email six months in advance of their revalidation deadline. Do not attempt to revalidate now as the Colorado interChange is in the process of being set up to accommodate the revalidation process.  Attempting to revalidate by completing a new application will create duplicate enrollments and cause claim processing issues.

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.

 
What can providers do now to prepare?
  • Ensure all the data in each enrollment profile is correct prior to revalidation. Providers have 3 email addresses on file and the "contact" email address is used for provider enrollment communications.
  • Ensure each NPI for Health First Colorado is also enrolled with Medicare.
    • If a provider needs to add a new NPI to an existing Medicare enrollment, visit the Medicare Enrollment Application web page. The CMS-855 applications specific to organizations are the 855A and 855B forms. Section 4 of each of these applications is where a provider can add an NPI.
    • How long does the process takes once the application is submitted? Applications are processed first in/first out, and most applications are processed in 45-60 days.
    • What effective date would be assigned to a new NPI added in PECOS? Since the NPI is being added to an existing enrollment, there would be no change in the provider’s Medicare effective date.
    • Will a new Medicare ID be assigned with the new NPI? The Medicare ID would stay the same.
What do providers need to know?
  • Quick guides will be published prior to revalidation.
  • 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.
 
 
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