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Health First Colorado covers behavioral health services. Behavioral health services are primarily delivered by the Regional Accountable Entity (RAE). For those which are not, this benefit applies.
Enrolled members under these circumstances:
Reference the billing and policy manual for complete details.
A variety of CPT billing codes are available for billing. These include but are not limited to:
Beginning July 2018 members have up to 6 short-term behavioral health visits per fiscal year covered in the primary care setting, billed FFS to the fiscal agent DXC. Refer to the ACC Phase Two web page for exact details on this policy.
The following licensed providers are eligible to provide behavioral health services: Physician/psychiatrist, Psychologist, Psy.D / Ph.D, Licensed clinical social worker (LSCW), Licensed marriage and family therapist (LMFT), Licensed professional counselor (LPC), Nurse Practitioner, Physician Assistant.
As a Health First Colorado (Colorado's Medicaid Program) provider, you have the opportunity to improve the health and well-being of more than a million Coloradans. Health First Colorado is more than health insurance – it is a vital public service, helping almost one in five Colorado citizens stay healthy or move towards better health.
The enrollment process is online and begins on the Provider Enrollment web page.
Enrollment in Managed Care networks is only required if the member being treated is in the Denver Health or Rocky Mountain Health Plan networks.
Behavioral health FFS services are reimbursed according to the current Health First Colorado Fee Schedule. Reimbursement rates will vary by CPT code reported. The fee schedule shows the maximum allowed reimbursement for each CPT code. Submitted claims will be reimbursed according to ‘lesser-of’ pricing logic. This means that the line item will reimburse either at submitted charges or the fee schedule rate, whichever is lesser.
Providers must first enroll into the program to submit claims. Once they are enrolled, providers may submit claims directly by logging into the Provider Web Portal. Claims may be submitted by billing agencies on behalf of the provider.
Resources for enrollment and billing may be found at Provider Resources.
All Medicaid Rules, Regulations, and Statutes apply to the administration of the Colorado Medical Assistance Program at large, which providers are required to follow. The following are specifically called out as the ones governing the behavioral health benefit: