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Unless otherwise noted below, each service location must be enrolled separately by submitting a separate application, and paying an additional application fee (if applicable). In instances where services are provided in a Health First Colorado or Child Health Plan Plus (CHP+) member’s residence or other non-provider owned setting, providers will need to use their main office location as the service address. Additional office locations, where no services are provided to members, do not need to be enrolled.
Please also be sure to review each of the specialties/services below for all requirements, including whether you are required to contact the Colorado Department of Public Health and Environment for additional requirements or approvals. To contact CDPHE to submit a Letter of Intent go to www.healthfacilities.info, then click "get licensed or certified", then "submit letter of intent."
You should only submit one application for the HCBS provider type that includes all of your specialties or the services you provide. You do not need to submit a separate application for each type of waiver (DD/SLS/CES, EBD/BI, etc).
You only need to submit additional applications if you have additional service locations or if you are applying for an additional provider type outside of HCBS.
When selecting multiple specialties, select all appropriate specialties/services on the same application.
Copy of IRS 147c EIN Verification Letter (For EIN enrollments only)
Copy of IRS 147c EIN Verification Letter
Resume, or letter from previous employer on company letterhead indicating applicable experience.