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Click on the provider types below for more enrollment details.
ENROLLMENT TYPE: Atypical
ENROLLMENT TYPE: Facility
ENROLLMENT TYPE: Individual within a Group – affiliates to a group and the group bills
Billing Individual – directly bills for themselves
OR
Ordering, Referring, Prescribing – limited to Ordering/Referring/Prescribing
IMPORTANT: If you are a Behavioral Health provider serving individuals with mental illness and/or substance use disorders, do NOT select this provider type. Please refer to information for Non-Physician Practitioner Groups (25) and/or Substance Use Disorder Clinics (64).
Each service location must complete a separate application
Credentialed professionals (the rendering providers) must be enrolled individually (separate application), and affiliated with the clinic. Affiliations are restricted to Provider Type 84, Specialty 831-Behavioral Therapist, Provider Type 37, Specialty 520-Licensed Psychologist, Provider Type 38, Specialty 521 Licensed Behavioral Health Clinician.
For new enrollments, the clinic must be approved prior to enrollment of the individual practitioners
ENROLLMENT TYPE: Individual within a Group – affiliates to a group and the group bills OR
Billing Individual – bills directly for themselves
Credentialed professionals (rendering providers) must be enrolled individually (separate application) and affiliated with the group. Rendering providers must be Certified Nurse Midwives or Physicians
No Direct Entry Midwives (non-DORA certified) are to be enrolled
For new enrollments, the group must be approved prior to enrollment of the individual practitioners
Billing Individual – bills directly for themselves OR Ordering, Referring, Prescribing – limited to Ordering/Referring/Prescribing
ENROLLMENT TYPE: Group
ENROLLMENT TYPE: Individual within a Group – affiliates to a group and the group bills OR Billing Individual – bills directly for themselves
ENROLLMENT TYPE: Individual within a Group - affiliates to a group and the group bills OR Billing Individual - bills directly for themselves OR Ordering, Referring, Prescribing - limited to Ordering/Referring/Prescribing
THIS PROVIDER TYPE IS NO LONGER AVAILABLE FOR NEW ENROLLMENTS. Family planning services currently may be provided under the Clinic – Practitioner or Non-Physician Practitioner – Group, provider types. Please review those provider type requirements to select the appropriate entity based on your credentialed professionals.
ENROLLMENT TYPE: Individual within a Group - affiliates to a group and the group bills Billing Individual - bills directly for themselves OR Ordering, Referring, Prescribing - limited to Ordering/Referring/Prescribing
ENROLLMENT TYPE: Individual within a Group - affiliates to a group and the group bills OR Billing Individual - directly bills for themselves
Osteopaths (DO): do not select this provider type. Osteopaths must select Provider Type 26/501.
ENROLLMENT TYPE: Individual within a Group – affiliates to a group and the group bills Ordering, Referring, Prescribing – limited to Ordering/Referring/Prescribing
ENROLLMENT TYPE: Billing Individual – directly bills for themselves
THIS PROVIDER TYPE IS NO LONGER AVAILABLE FOR NEW ENROLLMENTS. Services may be provided under the "Licensed Behavioral Health Clinician" Provider Type.
Note: Out of State service locations must provide products that are not available from an in-state provider. For product review, email a list of products to the DMEPOS benefit manager at Alex.Weichselbaum@state.co.us prior to submitting an enrollment application. Please include a contact name and phone number.
