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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 Remittance Advice (RA)
Updating your EFT/ERA Information
Validating a Trading Partner ID (TPID)
Verifying Member Eligibility, including:
Web Portal Registration
A “Suspended” claim status in the new Provider Web Portal, is the same as the “In Process” status you would have seen on the legacy Provider Claim Report (PCR).
Suspended claims require manual review by HPE Claims staff before a final disposition (status) can be assigned.
Claims also suspended in the legacy MMIS, and required manual review. The difference between the legacy and the current portal, is that the new Provider Web Portal shows you a level of detail you are not accustomed to seeing.
Over the next couple of weeks, a large percentage of claims will suspend. Both HPE and Department staff are reviewing claims as they come in to ensure they are correct and identify any issues.
Over the coming weeks, the number of claims requiring manual review will be reduced, as will the number of suspended claims. Suspended claims require no further action on your part, and the claim status will be updated as soon as it's changed to “Paid” or “Denied”.
Batch (X12), EDI, & Trading Partner Questions
General Provider Web Portal Questions
Updating Provider Information/Affiliations
Member Information/Verification Questions
Provider Web Portal Registration/Delegation
Alerts & Secure Correspondence
Online bill pay
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 HPE TPID.
You do NOT need a HPE 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 EDI HelpDesk at: 1 (844) 801-8482
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:
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 (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 HPE to verify they are enrolled for 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: 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 EDI HelpDesk at: 1 (844) 801-8482.
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.
You will be able to download Remittance Advice (RA) reports, Prior Authorization (PA) reports, Prior Authorization (PA) letters and CTMS letters from the Provider Web Portal.
No. We will transfer over 6 years of claims data, but not in the form of reports. Please make sure you download any reports you want before March 11, 2017. March 11, 2017 is the last day to access the legacy Web Portal, including reports and PAR letters.
According to dictionary.com, a file delimiter is, “a blank space, comma, or other character or symbol that indicates the beginning or end of a character string, word, or data item.”
While an excel file may look like this:
a file with a comma as the delimiter, would show you “Column 1,Column 2,Column 3”.
Yes, you can change your preferred file delimiter at any time in the “My Profile” section of the Provider Web Portal.
The new Provider Web Portal does not have the capability to automatically send reports out to different parties. However, your Trading Partner may log into their Trading Partner account and pull your 835 report at any time, so long as you have authorized their TPID to do so.
It’s not a problem, but you’ll probably receive some emails you don’t need. If you would like to disenroll, just call the EDI HelpDesk at 1 (844) 801-8482.
They can be opened from the portal and printed which initiates a temporary download. The file size is very small so this option really depends on preference.
As of right now, there is no limit. The Department will notify you if this changes.
The accept/reject report will no longer be a report option; the 999 will be still be available. Please review the Guide to Go Live more information on report changes.
Yes, you can take a session as many times as you like. You can also view a recording of the sessions on or after February 6th.
The content is PowerPoint versions of the slides demo’d in the session. You can request them by sending an email with which sessions you would like to email@example.com
No. Web Portal training is not a prerequisite for Enrollment, Revalidation, or Provider Web Portal registration. However, enrolment/revalidation training is highly recommended.
Certificates will not be issued; however, we do have attendance records if they are needed at a later date.
We recommend it; however, it’s not required.
If your enrollment or revalidation application was approved prior to February 3, 2017, then you should not use your 8-digit legacy ID to register for the Provider Web Portal. You need to use your new 10-digit system generated ID to register for the Provider Web Portal, otherwise you will only see historical claim information and will not be able to submit claims. If you do not have your new Provider ID, please call 1-844-235-2387.
No. The Provider Web Portal was built to be used with any modern Web Browser. You can see the Website requirements here: https://colorado-hcp-portal.xco.dcs-usps.com/hcp/provider/Home/WebsiteRe...
This updated information should have been provided during your revalidation in the new system. If it has changed you can update it using Provider Maintenance in the Provider Web Portal.
This is the service location ID and is usually the same as the Provider ID.
The user will be requested to update their password after 90 days.
Old Web Portal login information will not work for the new Provider Web Portal.
The provider can use the Forgot User ID and Forgot Password functionality of the Provider Web Portal to determine their User ID or Password. However, if they are locked out, they will need to call Provider Services (1-844-235-2387) to reset the lock.
Only the following providers are eligible for an EFT exemption:
If the above applies to you, and you want paper checks, please see these EFT exemption instructions.
No, if you provided your EFT information during revalidation you do not need to provide it again.
You can change your EFT information online through the new Provider Web Portal. You will just login, and click the link that says “EFT/ERA Enrollment”. You will receive paper checks for two weeks after changing your EFT information, though, so make sure your mailing address on file is also up to date. You can find detailed instructions for changing your EFT/ERA here.
No. EFT information will not migrate over from Xerox. However, any EFT information you submitted in your enrollment or revalidation application will remain in the system.
The EFT/ERA information is for the billing (group) provider.
Existing Enrolled Provider with an NPI
Provider must contact 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 NNPES, PECOS, Lexis Nexis. In the event that the application the provider is submitting requires an application fee, the provider can give HPE the previous ATN so that HPE can verify that the fee was paid. If the application requires attachments HPE will tie the applications together via enrollment comments.
Existing Enrolled Provider with no NPI on file
Provider must contact HPE via secure correspondence link on the Portal to have the old NPI closed. The provider should give the new NPI. HPE will first verify that the provider has no existing NPI on file. The enrollment Analyst will then conduct the standard manual checks to verify an NPI. This includes NNPES 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 NNPES, PECOS, Lexis Nexis.
You will need to login to the Provider Web Portal as either the Individual within a Group or a Group, and then click the Provider Maintenance link. From here you can click “Group Affiliations” or Affiliations" and then add the information. You can find detailed instructions for Affiliations here.
Important: Individuals Within a Group must be affiliated to a Group! Affiliating an individual to any other Enrollment type (Facility, Atypical, etc.), will likely cause claim denials.
A separate revalidation enrollment application should have been submitted for each service location, unless the provider is an Individual within a Group. If the provider is an Individual within a Group, they just need to affiliate to each Group location. If the provider is not an Individual within a Group, a separate enrollment application needs to be submitted for each service location.
It is not required, unless you participate in (and have a signed contract with) a Managed Care Organization (MCO) or Behavioral Health Organization (BHO). This lets the MCO or BHO bill for the provider. It also allows members to search for a provider who is in that network.
A new Provider Enrollment Application will need to be submitted for any new service location. In accordance with federal regulations and guidance, providers with multiple service locations (sites) must enroll each service location separately.
If they do not require approval, within 24 hours. If they do, then it depends on how long verification takes, generally 3-5 business days.
You may add or update a secondary Specialty; however, a change to Provider Type or Primary Specialty will require a new Provider Enrollment Application.
If they are just leaving your group, but do not want to end their participation with Health First Colorado, you can just remove them from your list of affiliated providers.
If they are leaving your group and ending their participation with Health First Colorado, that should be a disenrollment.
If the provider you want to add is already enrolled as an Individual within a Group, they can just add you to their list of affiliated groups, or you can add them to your list of affiliated providers.
If the provider isn’t enrolled with Health First Colorado yet, then they will need an enrollment application.
No. As of 3/1/17, all updates to provider information need to be made online through the new Provider Web Portal.
Yes. The information shown in the Provider Web Portal is populated from the information you gave us during revalidation or enrollment. You only need to make a change if you need to add, remove, or update informatin.
Yes. You should receive an email confirming your update request, and then another when the update has been made.
The provider should use the disenroll section if they are ending their participation with Health First Colorado. If the provider is just leaving your group, but does not want to end their participation with Health First Colorado, you can just remove them from your affiliated providers list.
Only claims where you are the billing provider, per HIPAA regulations.
Yes, you can verify if the Member is eligible for dental benefits.
Yes, and only one month at a time.
The Client Overutilization Program (COUP, also known as ‘Lock-In’) is a statewide surveillance and utilization control program that safeguards against unnecessary or inappropriate use of care or services. The Lock-In Details describe the provider(s) the member is eligible to see for the given service.
Yes, the Member’s Managed Care Assignment will be listed on the Coverage Details page within the Provider Web Portal. A member’s Medicare insurance will display on the Other Insurance Detail Information page of the Provider Web Portal.
Yes. Member IDs will not be changing,
Yes, the Limit Details section will display both dollars and units.
The Verification for Newborn option can be used to look up Newborn eligibility information, if the newborn Member ID is not known.
No, not through the Provider Web Portal.
The Member Focus viewing page will show the members city and state.
If you have enrolled. have been approved, and have registered for Provider Web Portal access, yes.
Yes, there is a Print Preview button at the top of the Coverage Detail page.
Yes, Member ID is the same as Client ID.
Both! You will need to log-in as an individual to update your license information and other practitioner details; you will need to use your company NPI for billing.
A provider (or administrator, if the provider has someone else in charge of submitting their enrollment) will use the provider’s information to register with the Provider Web Portal. This provider (or administrator) can then create delegates for each user in the company who may need to access the Provider Web Portal on behalf of the member.
A provider (or administrator, if the provider has someone else who is in charge of submitting their enrollment) will use the provider’s information to register with the Provider Web Portal. This provider (or administrator) can then create delegates for each user in the company who may need to access the Provider Web Portal on behalf of the member.
As an MCO, your Provider ID will be the same as your legacy ID. The Provider Web Portal login information will be changing with the new system, and will be created by you during registration. The new system will also require a HPE Trading Partner ID for those who will be submitting/receiving X12 transactions.
A provider will use the Manage Accounts page within the Provider Web Portal to enter their delegates' information and will receive a delegate code for each delegate. The Delegate will then use their information, along with the assigned delegate code, to register with the Provider Web Portal.
Using the delegate functionality available in the Provider Web Portal is the best way. Each group and provider will link to the delegate on the Manage Accounts page. The delegate will then be able to use their one login to switch between each group and provider that has assigned them as a delegate.
Both groups and individual provider can add delegates.
Yes, just return to the Manage Accounts page, click on the delegate’s name, and update the functions they are able to access on your behalf.
No, if the group is the billing entity on the claim, the group will register with the Provider Web Portal and be able to submit claims for the provider.
Correct, if they are not already a delegate for another provider and do not have a delegate code for the new Provider Web Portal, then you will use the first tab. If the delegate is already assigned to another provider and already has a delegate code for the new Provider Web Portal, then you will use the second tab.
Yes, you will register the group and the individual providers with the Provider Web Portal.
The Trading Partner will need to be linked to each billing provider. The Trading Partner does not need to be linked to the rendering providers.
No. If you are a billing agent with a Trading Partner ID, you will register with the Provider Web Portal using your Trading partner ID. Each of the providers you work on behalf of will need to use the Manage Accounts page to indicate which Provider Web Portal functions and X12 transactions you can perform on their behalf.
No, you will need to register with the Provider Web Portal to create a User ID and Password for the new system.
No, the group will register with the Provider Web Portal to update their location information.
For a given delegate (one individual), the same delegate code should be used for all providers (locations) for which they are a delegate. This will allow the delegate to have one login to the Provider Web Portal where they can then switch between providers using the Switch Provider function in the Provider Web Portal.
Under registration: If we have two separate providers (two different Provider ID's) can we register once and link both providers or do we have to register separately?
Each provider would register separately.
You will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted. So if you submitted 2 Provider Enrollment/Revalidation applications you will need two different provider registrations. However, if you have two taxonomies on the same Enrollment/Revalidation application, you will only need to have one provider registration and you will register with the primary taxonomy.
Yes, a RCCO will be able to add delegates.
You will enter the Group NPI when registering the group, and the individual NPI when registering the individual provider.
Registration for the Provider Web Portal is different than Revalidation. Registering with the Provider Web Portal will give you access to the new Provider Web Portal and can only occur after your Revalidation application has been approved.
A delegate code is provided by the first provider to add you as a delegate.
You will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted. If some employees work for both programs the delegate functionality can be used. For a given delegate (one individual), the same delegate code should be used for all providers for which they are a delegate. This will allow the delegate to have one login to the Provider Web Portal where they can then switch between providers using the Switch Provider function in the Provider Web Portal.
Yes, you will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted. You can then assign delegates for each in the Provider Web Portal. For a given delegate (one individual) the same delegate code should be used for all providers they are a delegate for. This will allow the delegate to have one login to the Provider Web Portal where they can then switch between providers using the Switch Provider function in the Provider Web Portal.
Yes, you would add them as a new delegate in the new Provider Web Portal.
Yes, if you did not provide an NPI during revalidation you can use your Provider ID to register with the Provider Web Portal.
You will receive two emails after you have registered with the Provider Web Portal. In the first email there will be a link that you must click and then enter your Password to verify your registration. After this verification, you will receive a second email indicating you have successfully registered.
No, you can only register as a Provider once with the NPI and taxonomy that was submitted during Enrollment/Revalidation. The provider will then create the necessary delegates for others that need to work on their behalf.
You will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted.
Yes, your application needs to be approved to register in the Provider Web Portal.
This is not the recommended process but the system will not stop you from doing this.
Each enrollment needs to register with the Provider Web Portal. Then, within each registration you can assign the same delegate. You can then use this one delegate to login to the Provider Web Portal and switch between the different providers.
Use the Primary taxonomy code.
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 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.
All enrollment inquiries and questions can be sent to COProviderEnrollment@HPE.com.
Yes, but you are not able to reply to a Closed Secure Correspondence message. Closed 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 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.
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.