Colorado Indigent Care Program (CICP) Information For Providers

Please contact the Department to request a blank copy of the 2017-18 Annual Provider Application

• Clinic Client Excel Application - Current version
• Hospital Client Excel Application - Current version
• FPL Calculator 

• Lawful Presence Affidavit - English
• Lawful Presence Affidavit - Spanish
• Lawful Presence Waiver

• Blank Clinic Satellite Worksheet
• Blank Hospital Satellite Worksheet

Provider Summary

• FY 2017 Data
• FY 2016 Data

Physician Billing

• FY 2017
• FY 2016

Pharmacy Billing

• FY 2017
• FY 2016

SAVE
All SAVE access requests, modifications, revocations must be submitted to cicpcorrespondence@state.co.us

• SAVE Access Request
• SAVE Modification/Revocation
• Example Access Request 
• Example Modification/Revocation

The examples show the highlighted fields that are required, incomplete or incorrect applications will be returned​

• July 6, 2017 - Adivosry Council Applications
• June 27, 2017 - Additional Information
• May 30, 2017 - Training
• May 22, 2017 - Distribution Lists
• April 24, 2017 - April Stakeholder Forum
• March 28, 2017 - Client Application
• March 16, 2017 - FPL Update
• February 6, 2017 - Distribution List