Should I fill out the Standard or Rendering App?

Standard or Rendering Application Options

Which application to complete and submit?

Enrollment applications are based on how reimbursements are reported to the Internal Revenue Service (IRS) and provider type. Some provider types must enroll using a federal Employer Identification Number (EIN) and individuals must enroll using a Social Security Number (SSN).

Standard Provider Application enrollment most often requires the use of an EIN, with a few exceptions for enrollment using a SSN. This is a direct pay, or billing entity, where reimbursements are reported to the IRS under the EIN. Enrollment using an EIN may require at least one association, or affiliation, with the individual that will directly see/evaluate the Colorado Medicaid member. The direct pay entity usually submits claims on behalf of the rendering individual where appropriate.

Rendering Provider Application enrollment requires a SSN only. A rendering provider is the individual that provides services to a Colorado Medicaid member. The rendering provider will affiliate with a clinic/facility that will submit claims and provide reimbursement to the individual.

If an individual has obtained an EIN to identify a business entity, both a rendering and a standard application may need to be completed. For instance a dentist will need to enroll once as a rendering provider (using his/her SSN) to provide services to the Colorado Medicaid member, and as a dental clinic (using the EIN) to complete the Standard Provider Application to submit claims.

Download the Standard Provider Application by clicking this link Download the Rendering Provider Application by clicking this link
For further assistance please contact: Xerox State Healthcare Provider Services Call Center: 1-800-237-0757