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Use these step-by-step illustrated instructions to help you navigate the Provider Web Portal.
Aid Code and Benefit Plan Acronyms
Are you Billing from the Correct Account?
Copy, Adjust, or Void a Claim
Delegate Access Definitions
Provider Maintenance, including:
Pulling your 835 - linking to your own TPID
Pulling your Remittance Advice (RA)
Reading your Remittance Advice (RA)
Updating your EFT/ERA Information
Validating a Trading Partner ID (TPID)
Verifying Member Eligibility, including:
Viewing Prior Authorizations in the Portal
Web Portal Registration
Entering Other Insurance or Medicare Crossover Information on a Claim
Alerts & Secure Correspondence
Batch (X12), EDI, & Trading Partner Questions
General Provider Web Portal Questions
Interim Payments NEW
Member Information/Verification Questions
Online bill pay
Provider Web Portal Registration/Delegation
Updating Provider Information/Affiliations
For Reference:Julian Calendar / Leap Year Julian Calendar
Some changes with the transition
Related to Provider Web Portal
Related to Claims
Please refer them to the companion guides at Colorado.gov/HCPF/EDI-Support for more details.
Yes, batch (X12) files can be transmitted through a Clearinghouse and through the Provider Web Portal; both methods (of batch submission) require a Trading Partner ID.
If you want to transmit batch through the Web Portal, you need to obtain a DXC Technology TPID.
You do NOT need a DXC Technology TPID, to submit single claims (not batch) through the Web Portal.
Yes, a TPID is needed to upload 837 files.
Yes, if you would like to download your own 835 you will need a TPID. You will also need to use the Manage Accounts page within the Provider Web Portal to define which TPID will submit your claims and which TPID will receive your 835.
A Billing Agent will be able to create delegates who can then upload and download files.
Providers could use the file exchange to upload and download batch files (including X12 reports) directly through the Provider Web Portal, rather than through FTP or through a Clearinghouse.
Yes, it is fairly common for a Clearinghouse to act as a Trading Partner for multiple providers. Note: A Clearinghouse could use the same TPID with all of their clients (providers).
No, the Provider Web Portal will not give indication that a Trading Partner serves more than one provider.
Please visit our EDI Support webpage, or call the Provider Services Call Center at 1-844-235-2387.
No, you do not need to enroll as a Trading Partner to submit single (interactive) claims through the new Provider Web Portal.
No, your vendor would need to enroll as a Trading Partner, but you would not.
Not necessarily. If you’re submitting your claims individually through the Provider Web Portal but typing the claim information into the portal, you are not submitting batch files. Batch is a technical term and does not refer to “many” claims, but rather the file format.
You do not need a TPID to:
You do need a TPID to:
Not necessarily, a Group is the billing provider for one or more individuals within a Group (rendering providers). Example: Salud Clinic may be a Group, and the doctors who work there may be the Individuals within a Group. Health First Colorado will report the income paid to Salud, to the IRS.
A Trading Partner is someone who submits batch claims or eligibility files on behalf of a billing provider, but may not receive the income from Health First Colorado. Example, Trizetto may submit claims for Salud Clinic, but does not receive the income from Health First Colorado. They are simply handling the file transmission to or from the fiscal agent, DXC Technology (formerly HPE).
If Salud submits their own batch files, however, they would be the Group and the Trading Partner in that instance.
Yes, if you are going to retrieve your own 835, you will need a Trading Partner ID.
A trading partner is anyone who trades information (submits or retrieves the X12 HIPAA compliant file). If you are not submitting your own X12 files or retrieving your own X12 files, you do not need a trading partner ID.
Health First Colorado does not make recommendations for who you should use as a Trading Partner, but a Google search for “medical claims Clearinghouse companies” should give you a good place to start. You can contact DXC Technology (formerly HPE) to verify they are enrolled in the Health First Colorado program.
You will want to register for the Provider Web Portal. If you are going to be the primary user of the Provider Web Portal, then you don’t need to be a delegate.
Either will work. The display name is something you’ll only see in the Provider Web Portal, and the display name won’t affect your claims (or anything else).
NOTE: A temporary issue with Display Names has been identified. Please review this work-around.
That’s really a personal preference. However, if you have a billing person or Department, you may want to check and see if they have a preference. Otherwise, you can just stick with the default option and change it later if you need to.
We do have a list published here, but you can also check with your billing agent. They will need to give you their TPID in order for you to "authorize" them as a Trading Partner.
Yes, the Search Payment History panel on the Provider Web Portal will provide this information for providers. You do not need to enroll as a trading partner to access remittance advice (RA), previously called provider claim reports.
Not necessarily. You could submit single claims (through the Provider Web Portal) on behalf of your clients, and that would not require you to be a Trading Partner. However, it would require each of your clients to "delegate" claims access to you.
Yes, anyone who wants to transmit batch (X12) files needs to enroll as a Trading Partner, and complete file testing for HIPAA compliance.
Yes, both you and your Clearinghouse can enroll as Trading Partners and receive a Trading Partner ID. Then on the Manage Accounts page within the Provider Web Portal you will indicate which transactions each Trading Partner ID will submit/receive.
While you could enroll for 16 different Trading Partner IDs, we recommend that you only enroll for one Trading Partner ID, and authorize that TPID to submit for all your locations.
There is no minimum threshold for batch claims. Batch is a technical term referring to the file type and method of submission:
Here is our Getting Started Guide, but you can also visit our EDI Support webpage, or call the Provider Services Call Center at 1-844-235-2387.
The testing process for Trading Partners is a separate process, not requiring access to the parts of the Web Portal that are not yet active.
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a file with a comma as the delimiter, would show you “Column 1,Column 2,Column 3”.
If you do not fit either of the above situations, please call the Provider Services Call Center (1-844-235-2387) to determine why your account has been restricted.
If the above applies to you, and you want to receive paper checks, please see these EFT exemption instructions.
Existing Enrolled Provider with an NPI
Provider must contact DXC Technology (formerly HPE) via secure correspondence link on the Portal to have the old NPI closed. The provider should then submit a new application with the new NPI number. This application will go through all of the standard enrollment checks including NPPES, PECOS, Lexis Nexis. In the event that the application the provider is submitting requires an application fee, the provider can give DXC Technology the previous ATN so that DXC Technology can verify that the fee was paid. If the application requires attachments DXC Technology will tie the applications together via enrollment comments.
Existing Enrolled Provider with no NPI on file
The Provider must contact DXC Technology (formerly HPE) via secure correspondence link on the Portal to have the new NPI added. DXC Technology will first verify that the provider has no existing NPI on file. The provider should give the new NPI and tax ID or Provider ID. The enrollment analyst will then conduct the standard manual checks to verify an NPI. This includes NPPES and PECOS. The NPI will go through Lexis Nexis in the next monthly batch cycle.
Provider that has not completed the Enrollment Process
The Provider should contact the Provider Call Center to request that the application be returned to them. They can then add the NPI and it will continue the enrollment process including all standard enrollment checks including NPPES, PECOS, Lexis Nexis.
Yes. You can view claims submitted through any media: paper, electronic batch, portal.
You can copy any adjudicated claim (one that is denied or paid), including claims from Xerox. A suspended claim cannot be copied.
If you will use the Provider Web Portal to submit individual claims via the Submit Claim process, you do not need a Trading Partner ID. You only need a Trading Partner ID if you are going to submit/receive X12 transactions.
You can submit single claims thru the Provider Web Portal.
A provider and/or anyone to which the billing provider has delegated claims inquiry access, will only be able to see the claims on which they are the “billing provider”. The RAs will have the Provider ID on them.
If you only enter individual claims via the Provider Web Portal you do not need a Trading Partner ID. You will only need a Trading Partner ID if you will be submitting/receiving X12 transactions.
Yes. Only dental claims for members who have a non-citizen, emergency services only eligibility status, will be submitted via the provider Web Portal. All other Dental claims for Health First Colorado members will continue to be processed through DentaQuest.
The main call center number will have an option specifically for claims on 3/1/17. You can also use the secure correspondence option in the portal. The Call Center is open 8am -5pm Mon. thru Fri. 1-844-235-2387.
You will use the new Provider Web Portal to submit your individual claims.
You would have to do either an adjustment or a reconsideration after the originally submitted claim has been adjudicated.
Via the Provider Web Portal, providers will have access to all of their claims stored in interChange. Xerox data from the past 6 years will be migrated into the new system.
You will be able to use the new Provider Web Portal to submit claims with attachments. On Step 3 of the Submit Claim process in the new Provider Web Portal, there is a section where you can upload your attachments and submit them with the claim.
Yes, but the LBOD is now done differently. Instead of submitting an LBOD, you will enter the last submitted ICN for that service in the Previous ICN field. Please review the Guide to Go Live for more information on LBOD changes.
Select crossover claim from the Claim Type dropdown menu. The Medicare Crossover Details section will be displayed to enter information.
The first two digits of the type of bill are the "Facility Type Code" (example - 13 for outpatient claims) - the third digit (frequency type) will be automatically added depending on what type of claim you are submitting (original vs adjustment vs void)
You could copy the claim for the patient for the month previous and modify that information to submit for the new month (using new dates of service).
The old portal will not be available. However, Xerox data will be back loaded and searchable in the new portal up to 6 years in the past.
The EQ Process will not change at all. If you have questions relative to how your Provider ID change affects the EQ process, contact EQ at 1-888-801-9355.
The PA number in interChange is 10 digits: 1 digit for the media type (how the PA enters interChange), 2 digits for the year, 3 digits for the Julian date, and a 4-digit sequence number.
Nursing Facility PETI and Referral PAs can be submitted via the DXC Technology (formerly HPE) Provider Web Portal. Referral PAs are completely optional and have no impact on your claims.
No, you only need to be a trading partner for batch eligibility and batch claims.
There is Provider Enrollment information and training available here.
Yes, but you are not able to reply to a Closed Secure Correspondence message. Close calls are logged in the CTMS (Call Tracking Management System) and accessible by the call center reps if further action is needed. When documenting your correspondence, please note the CTN (Call Tracking Number) automatically assigned to the case. This will make conversations with the call center easier to reference.
Any written communication containing PHI and protected by HIPAA. All correspondence with DXC Technology (formerly HPE), aka the fiscal agent for Health First Colorado.
Currently, the Provider Web Portal does not provide a print option for Secure Correspondence but you could use your browser's print capability.
The turnaround time depends on the question asked, but is typically 3-5 business days.
Yes, these type of questions can be asked via Secure Correspondence on the Provider Web Portal.
If the request is urgent, we suggest you call. Otherwise, secure correspondence is the preferred method of communication for non-urgent requests.
No, reconsiderations must be submitted via the Provider Web Portal, paper or batch. However, a reconsideration is not necessary for denied claims. Please correct the reason for denial and resubmit as a new claim.
No. If you believe you were denied services without cause, you should first submit a reconsideration for your claim via the Provider Web Portal, paper or batch. If you are not satisfied with the outcome of the reconsideration, you can appeal and ask for a State Fair Hearing. Call the Colorado Office of Administrative Courts at 303-866-2000. Or, write to:Colorado Office of Administrative Courts
1525 Sherman Street, 4th Floor
Denver, CO 80203
Do you have your Trading Partner ID (TP ID), but have not received your login information?
Have you completed the EDI enrollment but do not have your login information or TP ID?
Otherwise, please complete and submit the applicable EDI Enrollment Form as soon as possible. The State will follow up on the enrollment process and send you the necessary User Names and Passwords for accessing the Colorado Medical Assistance Program Web Portal.