Provider Revalidation & Enrollment

Enrollment Application Rejection Email: If you received a letter via email stating that your enrollment application has been rejected, please note that this is likely due to an additional application being submitted separately from the application which was ultimately approved. DXC automatically rejects applications which were Returned to Provider (RTP) after six (6) months in RTP status, resulting in the automated rejection letter. Providers who received this letter are advised to contact the Provider Services Call Center at 1-844-235-2387 to verify current enrollment status.

Training License Now Accepted for Ordering, Prescribing or Referring (OPR) Provider Enrollment: In response to provider concerns, the Department will now allow OPR providers with training licenses to enroll with Health First Colorado (Colorado’s Medicaid Program). OPR providers enrolling with a training license must use taxonomy code 390200000X on the enrollment application to indicate the training license. Training licenses are not accepted for Individual Within a Group (IWG) or billing individual enrollments; full licenses are required.

Individual Providers Enrolling with a Social Security Number (SSN) May Only Have One Medicaid ID: Providers with any of the following individual types may only have one application associated to a SSN, even if they provide services in multiple locations: Billing individuals; Individuals within a group (IWG); Ordering, prescribing and referring (OPR) providers. An additional application for any of these individual types with the same SSN and same NPI as a previous application (regardless of whether the individual type is the same as on the previous application) may result in the application being denied as a duplicate or denied claims. Individuals may affiliate with multiple groups in different locations.

Ordering, Prescribing or Referring (OPR) Application Not Required for Individual Within a Group (IWG) Providers with Prescriptive Authority: Providers with prescriptive authority who are enrolled as an active IWG (rendering provider) may be prescribers. They are not required to complete an additional OPR application. OPR enrollments are for providers who do not submit payment directly to Health First Colorado (Colorado’s Medicaid Program) but only prescribe, refer or order for Health First Colorado members. Submitting an OPR application with the same Social Security Number (SSN) as a previously enrolled IWG may result in the application being denied as a duplicate or in denied claims.

 

Thank you for your interest in becoming a Health First Colorado (Colorado's Medicaid Program) provider or your participation in revalidation. The following instructions apply to both new enrollments and revalidations.

Please do not begin the application before reviewing these online resources. An incorrect or incomplete application requires additional review that may add weeks to your application’s processing time.

  •   

 

Provider Services Call Center

Until further notice, the Provider Services Call Center (1-844-235-2387) hours will be:

  • 7 a.m. – 5 p.m. MT Monday, Tuesday, & Thursday
  • 10 a.m. – 5 p.m. MT Wednesday & Friday

The Provider Services Call Center will be utilizing the time between 7 a.m. and 10 a.m. on Wednesdays and Fridays to return calls to providers.

Download the Provider Services Call Center information sheet so you know which call queue can best assist you!

 

Need help with enrollment or revalidation? Check out this step-by-step guide and Revalidation Best Practices to help you avoid making mistakes.

 
 

Quick Tips and Facts for Enrollment & Revalidation:

  • Know your provider type(s) before beginning the enrollment/revalidation process.
  • Keep your contact information up-to-date.
  • Enroll before you see a Medicaid member.
  • Enrollment and revalidation is required for all medical and nonmedical Medicaid providers.
 
 

Beginning March 1, 2017, all providers are required to have completed the enrollment process in the new Colorado interChange, regardless of whether they were enrolled in Colorado Medicaid prior to the transition effective March 1.

All providers, medical or nonmedical, who are enrolled with and bill Medicaid for services under the state plan or a waiver must be screened under this rule by enrolling/revalidating. In addition, providers that provide services through Managed Care Organizations (MCOs), including Child Health Plans Plus (CHP+) and Behavioral Health Organizations (BHOs), need to enroll/revalidate as well. This is necessary because the validity and currency of all provider licenses to perform any service must be screened.

New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all existing (and newly enrolling) providers. These regulations are designed to increase compliance and quality of care, and to reduce fraud.