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The deadline for provider revalidation is rapidly approaching! Providers who do not begin the enrollment/revalidation process by August 1, 2016 put themselves at serious risk for delayed payments, as revalidation may take several weeks.
Providers who begin the process now, through the Online Provider Enrollment (OPE) tool, have ample opportunity to complete the process and receive their approval before the new enrollment and claims management system, Colorado interChange, launches on October 31, 2016.
Providers who have not enrolled into the Colorado interChange and received their approval by October 31, 2016, will not be able to submit claims or PARs, receive payments, or verify member
eligibility (until they are approved).
Revalidation and enrollment requirements will vary based on your provider type, so it's important that you know what provider type(s) you are or want to enroll as.
Please review the available provider types supported in our new claims payment system on this web page; these are the ONLY provider types the system will accept.
You are likely referring to the Home and Community Based Services (HCBS) provider type. There is important information for all HCBS providers on the Information by HCBS service provided web page.
If you are a dental provider who provides DIDD dental services; you do not need to enroll as more than one provider type. You will just enroll as a dental provider and submit your claims to DentaQuest for processing, for both services.
Your enrollment type will be dependent on a couple of different factors; including how your billing is set up and whether you want income reported under an EIN or SSN.
Here are the definitions for each enrollment type:
This enrollment type is for an individual that renders services but does not bill Health First Colorado (Colorado's Medicaid Program) directly. Providers must be associated with a Group that submits claims on their behalf.
This enrollment type is a clinic or practice that will submit claims on behalf of one or more Individuals within a Group provider enrollment type. Income is reported to the IRS under the business EIN.
This enrollment type is an individual who receives direct payment for services rendered and submits claims for his/her own services.
This enrollment type is for an entity that will be submitting claims for services rendered. An associated Individual within a Group provider enrollment type is not required/allowed.
Atypical providers are those who may not be required to have a National Provider Identifier (NPI) or taxonomy code. These providers may include, but are not limited to, Home and Community-Based Waiver Services (HCBS) providers, Managed Care Organizations (MCOs), and Behavioral Health Organizations (BHOs).
This enrollment type is for individuals who only order, prescribe or refer items or services covered by Health First Colorado (Colorado's Medicaid Program) for Health First Colorado members. These physicians and other professionals are not enrolled as an Individual within a Group or a Billing Individual and will not submit claims for payment of services rendered.
(Only the following provider types have the option to enroll as an OPR provider; Audiologist, Certified Registered Nurse Anesthetist, Dentist, Nurse Midwife, Nurse Practitioner, Optometrist, Orthodontist, Osteopath, Physician, Podiatrist, Psychologist PhD, Speech Therapist)
Make sure you cross check your provider type to your enrollment type, not all enrollment types are available for each provider type. You can see the enrollment types available for each provider type, by clicking on your provider type on our Information by Provider Type web page.
This is a common scenario; maybe you are a physician and you own your practice. Even if you are the only practitioner, if you want to use an EIN this is technically a business and in order to enroll your business, you will need to complete an application for a group. In this example, the group would be a "Clinic - Practitioner Group" provider type. Must use EIN as the Tax ID Type for the "group" application.
After the physician, in this example, has submitted an application for his/her business; they would also need to submit a second application as the practitioner. The application for the practitioner in this example would be an enrollment type of "individual within a group" and a provider type of "Physician". While completing the "individual within a group" application, the physician will indicate that they are affiliated to the group that was enrolled for the business. Must use the practitioner's SSN as the Tax ID Type for the "individual within a group" application.
This will allow the individual Physician to bill under their business EIN, even though services will still be rendered under their SSN.
Great question! Please review this document.
Before you start your application through the Online Provider Enrollment (OPE) tool, we highly recommend that you:
Now that you've taken the training, it's time to make sure you have all of the information you'll need to complete the application. Please review pages 4-6 in our Online Provider Enrollment manual, as well as the Information by Provider Type web page to view the required documentation for the provider type/enrollment type you are applying as.
After you know your Enrollment Type, you will find these checklists very helpful:
Initial revalidations are treated as new enrollments; we need you to submit the required documentation in order to complete your revalidation.
Copies of documents are fine.
All documents should be uploaded through the "attachments" section of your online application. Please do not upload your documents until you are ready to submit your application, the system will not hold your documents if you choose "Finish Later".
Our system will allow for an NPI to be used for more than one location, but it is up to each organization to determine if they have subparts that need their own NPI’s. If a provider is unsure whether it is a subpart of its organization, it should consult with the greater legal entity of their organization. Please see this CMS NPI Fact Sheet for more information about subparts and their importance.
Again, we highly recommend that you take the training and download the resources available prior to completing your application. If you are short on time download the Provider Enrollment Manual, at the very least!
You do not need to create a log-in to begin the Online Provider Enrollment (OPE) tool. Each application will be assigned a separate tracking number.
Yes, the application requires that you provide a mailing address, a service address, and a billing address; This does not mean that billing will occur.
This will depend on your provider type, please see our Information by Provider Type and Information by HCBS Service Provided pages.
Please visit our Next Steps page for further instruction and FAQs, especially if you are a new provider, or if you are applying for a service location not currently enrolled with Xerox State Healthcare.
This page - did you read through all of the steps?
Provider Enrollment Manual
Training (see step 3 above for instructions)
Please email Provider.Questions@state.co.us
The Provider Portal does not have a “password reset” feature until November, 2016. If you forgot your password, you can still resume your application by choosing “Forgot Password” and then answering the security questions correctly. If you forgot your password and the answer to your security questions, you will need to begin a new application.
Health First Colorado (Colorado's Medicaid Program) Enrollment and Revalidation Information Center
1-800-237-0757, option 5.
While questions can still be submitted to the Provider.Questions@state.co.us email, the Center gives providers the added ability to speak with a live provider enrollment specialist. If a specialist is unavailable, providers may leave a voicemail and include their name, a brief message, application tracking number, and a phone number so that a specialist may promptly address their questions and call back.