Children’s Habilitation Residential Program (CHRP) Waiver Program Billing Manual

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Overview

Home and Community Based Services (HCBS) are certain Health First Colorado benefits available to members in their homes and communities as an alternative to institutional care. HCBS programs for persons with developmental disabilities include the Children's Habilitation Residential Program (HCBS-CHRP).

Waiver programs provide additional Health First Colorado (Colorado's Medicaid Program) benefits to specific populations who meet special eligibility criteria.

Level of care determinations are made annually by the case management agencies (Community Centered Boards). Members must meet financial, medical, and program criteria to access services under a waiver. The applicant must be at risk of placement in a nursing facility, hospital, or ICF/IID (intermediate care facility for Individuals with Intellectual Disabilities). To utilize waiver benefits, members must be willing to receive services in their homes or communities. A member who receives services through a waiver is also eligible for all basic Health First Colorado covered services except nursing facility and long-term hospital care.

Each waiver has an enrollment limit. Applicants may apply for more than one (1) waiver, but may only receive services through one (1) waiver at a time.

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Prior Authorization Requests (PARs)

All HCBS services require prior authorization before they can be reimbursed by Health First Colorado. Community Centered Board (CCB) case managers complete the Prior Authorization Requests for their specific programs according to instructions published in the regulations for the Department of Health Care Policy and Financing (the Department).

The CCB's responsibilities include, but are not limited to:

  • Informing members and/or legal guardian of the eligibility process
  • Submitting a copy of the approved Enrollment Form to the County department of human/social services for a Health First Colorado member identification number
  • Developing the appropriate Prior Authorization Request of services and projected costs for approval
  • As the authorizing agent, submitting the prior authorization information to the fiscal agent A list of authorizing agents can be found by referring to Appendix D of the Appendices in the Provider Services Billing Manuals section
  • Assessing the member's health and social needs.
  • Arranging for face-to-face contact with the member within 30 calendar days of receipt of the referral
  • Monitoring and evaluating services
  • Reassessing each member
  • Demonstrating continued cost effectiveness whenever services increase or decrease

 

Approval of prior authorization does not guarantee payment and does not serve as a timely filing waiver. Prior authorization only assures that the approved service is a medical necessity and is considered a benefit of Health First Colorado. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g., timely filing, provider information completed appropriately, required attachments included, etc.) before payment can be made.

Prior approvals must be completed thoroughly and accurately. If an error is noted on an approved request, it should be brought to the attention of the member's case manager for corrections. Procedure codes, quantities, etc., may be changed or entered by the member's case manager.

The authorizing Community Centered Board is responsible for timely submission and distribution of copies of approvals to agencies and providers.

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PAR Submission

The HCBS-CHRP Pars are electronically submitted by case managers via the Bridge, which directly interfaces with the Colorado interChange. Case Managers can access the Bridge via the Medicaid Enterprise User Provisioning System (MEUPS).Back to Top

Claim Submission

Refer to the General Provider Information manual for general billing information.

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Children's Habilitation Residential Program (CHRP)

  • HCBS-CHRP is a residential service and support program for children and youth from birth through age 20. HCBS-CHRP provides services for children and youth i who have an intellectual or developmental disability and extraordinary needs that put them in at risk of, or in need of, out of home placement in a nursing facility, hospital, or ICF/IID.

The waiver provides support for eligible children who:

  • may require added support as they transition back to the family home from a foster care or residential setting
  • may require services to support their families in remaining in the family home.
  • have an intellectual or developmental disability or developmental delay if under age five (5), and have intensive behavioral and/or medical support needs that put them at risk or in need of out of home placement.
  • are willing to receive services in their homes or communities.

 

The waiver is designed to assist children/youth to acquire, retain, and/or improve self-help, socialization, and adaptive skills necessary to live in the community with a plan to include services. Enrollment into the HCBS-CHRP waiver occurs through area Community Centered Boards.

The following services are provided through CHRP when deemed appropriate and adequate by the child/youth's physician and they are to be provided in the community, as available:

  • Community Connector
  • Habilitation (Residential 24-hour support)
  • Respite Services
  • Intensive Support Services
  • Transition Support Services
  • Hippotherapy
  • Massage Therapy
  • Movement Therapy

 

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CHRP Procedure Code Table

Providers may bill the following procedure codes for CHRP services:

Children's Habilitation Residential Program (CHRP)
Description Procedure Code Modifiers
Community Connector
Community Connector H2021 U9
Foster Home
Foster Home Level 1 H0041 U9
Foster Home Level 2 H0041 U9, 22
Foster Home Level 3 H0041 U9,TF
Foster Home Level 4 H0041 U9,TF,22
Foster Home Level 5 H0041 U9,TG
Foster Home Level 6 H0041 U9,TG,22
Group Home
Group Home Level 1 T2016 U9
Group Home Level 2 T2016 U9,22
Group Home Level 3 T2016 U9,TF
Group Home Level 4 T2016 U9,TF,22
Group Home Level 5 T2016 U9,TG
Group Home Level 6 T2016 U9,TG,22
Residential Child Care Facility
Residential Child Care Facility Level 1 (Per Diem) T2016 U9, HA
Residential Child Care Facility Level 2 (Per Diem) T2016 U9, HA, TJ
Residential Child Care Facility Level 3 (Per Diem) T2016 U9, HA, TF
Residential Child Care Facility Level 4 (Per Diem) T2016 U9, HA, TG
Residential Child Care Facility Level 5 (Per Diem) T2016 U9, HA, TT
Residential Child Care Facility Level 6 (Per Diem) T2016 U9, HA, 22
Intensive Support Services – Supporting children to stay in the family home
Wraparound Facilitator Plan H2021 U9, HI, TL
Wraparound Facilitator Monitoring H2021 U9, HI, HN
In-Home Services H2021 U9, HI, HM
Professional Services
Hippo Therapy S8940 U9
Hippo Therapy Group S8940 U9,HQ
Movement Therapy-Bachelors G0176 U9
Movement Therapy-Masters G0176 U9,22
Massage Therapy 97124 U9
Respite Services – In the Home
Respite – in the Family Home/15 minute increments S5150 U9, HA
Respite - in the Family Home/Per Diem S5151 U9, HA
Respite Services – Residential Settings
Respite – in the Family Home/15 minute increments S5150 U9, HI
Respite - in the Family Home/Per Diem S5151 U9, HI
Transition Support Services – Supporting children in moving to family home
Wraparound Facilitator Plan H2021 U9, HA, TL
Wraparound Facilitator Monitoring H2021 U9, HA, HN
In-Home Services H2021 U9, HA, HM

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Paper Claim Reference Table

The following paper form reference table gives required and/or conditional fields for the paper CMS 1500 claim form for CHRP claims:

CMS Field Number & Label Field is? Instructions
1. Insurance Type Required Place an "X" in the box marked as Medicaid.
1a. Insured's ID Number Required Enter the member's Health First Colorado seven-digit Medicaid ID number as it appears on the Medicaid Identification card. Example: A123456.
2. Patient's Name Required Enter the member's last name, first name, and middle initial.
3. Patient's Date of Birth/Sex Required Enter the member's birth date using two digits for the month, two digits for the date, and two digits for the year. Example: 070114 for July 1, 2014.

Place an "X" in the appropriate box to indicate the sex of the member.
4. Insured's Name Not required  
5. Patient's Address Not Required  
6. Client Relationship to Insured Not Required  
7. Insured's Address Not Required  
8. Reserved for NUCC Use Not Required  
9. Other Insured's Name Not Required  
9a. Other Insured's Policy or Group Number Not Required  
9b. Reserved for NUCC Use    
9c. Reserved for NUCC Use    
9d. Insurance Plan or Program Name Not Required  
10a-c. Is patient's condition related to? Not Required  
10d. Reserved for Local Use    
11. Insured's Policy, Group or FECA Number Not Required  
11a. Insured's Date of Birth, Sex Not Required  
11b. Other Claim ID Not Required  
11c. Insurance Plan Name or Program Name Not Required  
11d. Is there another Health Benefit Plan? Not Required  
12. Patient's or Authorized Person's signature Required Enter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank or enter "No Signature on File".

Enter the date the claim form was signed.
13. Insured's or Authorized Person's Signature Not Required  
14. Date of Current Illness Injury or Pregnancy Not Required  
15. Other Date Not Required  
16. Date Patient Unable to Work in Current Occupation Not Required  
17. Name of Referring Physician Conditional  
18. Hospitalization Dates Related to Current Service Not Required  
19. Additional Claim Information Conditional  
20. Outside Lab?
$ Charges
Not Required  
21. Diagnosis or Nature of Illness or Injury Required Enter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition.

Enter applicable ICD-10 indicator.

HCBS
CHRP may use R69
22. Medicaid Resubmission Code Conditional List the original reference number for resubmitted claims.

When resubmitting a claim, enter the appropriate bill frequency code in the left- hand side of the field.
7 - Replacement of prior claim
8 - Void/Cancel of prior claim
This field is not intended for use for original claim submissions.
23. Prior Authorization Not Required HCBS
Leave Blank
24. Claim Line Detail Information The paper claim form allows entry of up to six detailed billing lines. Fields 24A through 24J apply to each billed line.

Do not enter more than six lines of information on the paper claim. If more than six lines of information are entered, the additional lines will not be entered for processing.

Each claim form must be fully completed (totaled).

Do not file continuation claims (e.g., Page 1 of 2).
24A. Dates of Service Required The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. Enter the date of service using two digits for the month, two digits for the date and two digits for the year. Example: 010116 for January 1, 2016.
From To
01 01 19               
or
From To
01 01 19 01 01 19
Span dates of service
From To
01 01 19 01 31 19
Practitioner claims must be consecutive days.
Single Date of Service: Enter the six digit date of service in the "From" field. Completion of the "To field is not required. Do not spread the date entry across the two fields.

Span billing: permissible if the same service (same procedure code) is provided on consecutive dates.
24B. Place of Service Required Enter the Place of Service (POS) code that describes the location where services were rendered. Health First Colorado accepts the CMS place of service codes.
03 School
11 Office
12 Home
34 Hospice
NOTE:
Use POS Code 12 (Home) for Foster Home, Group Home, and Respite Services. Use ether POS 11 (Office) or POS 11 (Home) where applicable for all other services. 
24C. EMG Not Required  
24D. Procedures, Services, or Supplies Required Enter the HCPCS procedure code that specifically describes the service for which payment is requested.

HCBS
Refer to the CHRP Rate Schedules on the Department's website.
24D. Modifier Required Enter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form.

HCBS
Refer to the CHRP Rate Schedules on the Department's website.
24E. Diagnosis Pointer Required Enter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis.

At least one diagnosis code reference letter must be entered.

When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow.

This field allows for the entry of 4 characters in the unshaded area.
24F. $ Charges Required Enter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.

Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one procedure from the same group is billed, special multiple pricing rules apply.

The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed.

Submitted charges cannot be more than charges made to non-Health First Colorado covered individuals for the same service.

Do not deduct Health First Colorado co-pay or commercial insurance payments from the usual and customary charges.
24G. Days or Units Required Enter the number of services provided for each procedure code.

Enter whole numbers only- do not enter fractions or decimals.
24G. Days or Units General Instructions A unit represents the number of times the described procedure or service was rendered.

Except as instructed in this manual or in Health First Colorado bulletins, the billed unit must correspond to procedure code descriptions. The following examples show the relationship between the procedure description and the entry of units.

Home & Community Based Services
Combine units of services for a single procedure code for the billed time period on one detail line. Dates of service do not have to be reported separately. Example: If forty units of personal care services were provided on various days throughout the month of January, bill the personal care procedure code with a From Date of 01/03/XX and a To Date of 01/31/XX and 40 units.
24H. EPSDT/Family Plan Not Required  
24I. ID Qualifier Not Required  
24J. Rendering Provider ID # Required In the shaded portion of the field, enter the NPI of the Health First Colorado provider number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic.
25. Federal Tax ID Number Not Required  
26. Patient's Account Number Optional Enter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA).
27. Accept Assignment? Required The accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program.
28. Total Charge Required Enter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
29. Amount Paid Not Required  
30. Rsvd for NUCC Use    
31. Signature of Physician or Supplier Including Degrees or Credentials Required Each claim must bear the signature of the enrolled provider or the signature of a registered authorized agent.

Each claim must have the date the enrolled provider or registered authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016.
32. 32- Service Facility Location Information
32a- NPI Number
32b- Other ID #
Conditional Enter the name, address and ZIP code of the individual or business where the member was seen or service was performed in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.
33. Billing Provider
Info & Ph #
Required Enter the name of the individual or organization that will receive payment for the billed services in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
33a- NPI Number Required  
33b- Other ID #   If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.

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CMS 1500 CHRP Claim Example

CMS 1500 CHRP Claim Example

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Timely Filing

For more information on timely filing policy, including the resubmission rules for denied claims, please see the General Provider Information manual available on the Billing Manuals web page under the General Provider Information drop-down menu.

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Home and Community Based Services (HCBS) Children’s Habilitation Residential Program (CHRP) Manual Revisions Log

Revision Date Addition/Changes Made by
12/1/2016 Manual revised for interChange implementation. For manual revisions prior to 12/01/2016, please refer to Archive. HPE (now DXC)
12/27/2016 Updates are based on Colorado iC Stage II Provider Billing Manuals Comment Log v0_2.xlsx HPE (now DXC)
1/10/2017 Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_3.xlsx HPE (now DXC)
1/19/2017 Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_4.xlsx HPE (now DXC)
1/26/2017 Updates based on Department 1/20/2017 approval email HPE (now DXC)
5/22/2017 Updates based on Fiscal Agent name change from HPE to DXC DXC
6/26/2018 Updated billing and timely HCPF
6/28/2018 Removed HCPCS (duplicated from general) HCPF
12/21/2018 Clarification to signature requirements HCPF
3/19/2019 Clarification to signature requirements HCPF
7/15/2019 Updated new services, removed Special Program Code references, clarified CCB responsibility, removed outdated services. HCPF
3/3/2020 Converted to web page HCPF
9/14/2020 Added Line to Box 32 under the Paper Claim Reference Table HCPF
10/2/2020 Updated language describing CHRP services and eligibility, Changed “Supported Community Connections” to “Community Connector,” corrected errors in the Respite modifiers, Place of Service instructions. HCPF
11/18/2020 Added in the new RCCF benefit effective 01/01/21 HCPF