Federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening for all existing (and newly enrolling) providers.
Does not obligate providers to see Health First Colorado members. Effective July 4, 2019, provider enrollment letters will now include the Health First Colorado ID.
What happens next? We offer contracts to any willing provider who meets all requirements to service Medicaid Members as a Primary Care Provider and Medical Home in the ACC Program, this includes: Copyright © 2020 Beacon Health Options. Find out if you qualify and how to easily apply for Health First Colorado, Colorado's Medicaid Program. Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid Program) providers must revalidate in the program at least every five (5) years to continue as a provider. Before the enrollment type can be updated from IWG to BI, providers must submit an Electronic Funds Transfer (EFT) update including a W-9 (with the SSN listed) and a voided check or bank letter (signed and dated within the last 6 months). A secondary question, ‘Is this entity an individual?’, must be answered ‘Yes’ when disclosing information for individual owners of the business.
In accordance with federal screening rule 42 CFR § 455.104 and Colorado Code of Regulations 10 CCR 2505-10 8.125.15, a verification is completed for all individuals and when the DOB does not match, the application is returned to the provider for correction(s) or denied. The National Provider Identifier (NPI) will also continue to be included in provider enrollment letters.
ATTENTION: Some providers can now temporarily enroll in Health First Colorado (Colorado's Medicaid Program) to provide services during the COVID-19 public health emergency. COVID-19 Provider Information; Access the SAVE System; Learn about the Colorado NPI Law Once the public health emergency designation is lifted, no new temporary enrollment applications will be approved.
If there is no ownership of 5%, the board of directors’ information should be entered, including addresses, dates of birth, and social security numbers for each individual listed. New applicants will be required to indicate temporary enrollment due to the public health emergency or long term enrollment. If you wish to have a home health agency administer Synagis to your patient, please indicate that the medication will be shipped to the patient’s home. Download an enrollment checklist based on the Enrollment Type(s) associated with the chosen Provider Type from step 1.
If only a training license is on file, then the provider must submit a current, full license through the Provider Web Portal. © 2019 State of Colorado | Transparency Online | Accessibility, An Overview of the Federal Medicaid Requirements for Ordering, Prescribing or Referring (OPR) Providers, Enrolling in Health First Colorado as an OPR Provider, Ordering, Prescribing or Referring (OPR) Application Not Required for Individual Within a Group (IWG) Providers with Prescriptive Authority, New Provider Specialties for COVID-19 Long-Term and Temporary Enrollment, Calendar Year 2020 Provider Enrollment Application Fee Amount, Enrollment Application Date of Birth (DOB) Requirement Reminder, Provider Enrollment Letters Updated to Include Health First Colorado (Colorado’s Medicaid Program) ID, Recommended Internal Revenue Service (IRS) Documentation for Provider Enrollment Application, Individual Providers Enrolling with a Social Security Number (SSN) May Only Have One Medicaid ID, Coronavirus Disease 2019 (COVID-19) in Colorado: State & National Resources, Information for Ordering, Prescribing, Referring (OPR) Providers, Behavioral Therapy Provider Attestation Form.
Providers enrolling with a training license must use taxonomy code 390200000X on the enrollment application to indicate the training license. If you need this document in another language, large print or on tape, please call Customer Service Monday through Friday from 8:00am-5:00pm at 1-800-511-5010 (toll free). A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Members are protected under the Federal Mental Health Parity and Addiction Equity Act (MHPAEA).
For questions, please contact Provider Services Call Center (1-844-235-2387). This may prompt individuals enrolled as OPRs to change their enrollment type to an IWG to allow them to be the rendering on a claim. Print all results.
Effective April 10, 2020, providers will be allowed to temporarily enroll in Health First Colorado (Colorado's Medicaid Program) to provide services during the public health emergency.
For further information regarding these Enrollment Types, please review the document Billing Individual vs Individual within a Group. An additional application for any of these individual types with the same SSN will result in the application being denied as a duplicate.
Incomplete information will result in a delayed response.
Member Handbook Manage Your Account. If you feel these rights have not been upheld, you can call the Behavioral Health Ombudsman at 303-866-2789, Email them at: [email protected]
, or go online at: Early and Periodic Screening, Diagnostic, and Treatment, Screening Brief Intervention & Referral To Treatment, [email protected]
, Be enrolled as a provider in the Colorado Medicaid program, Certified by the state as provider in the Medicaid and CHP+ Medical Homes for Children program, Individual physician, advanced practice nurse or physician assistant with a focus on primary care, general practice, internal medicine, family medicine, pediatrics, geriatrics, or obstetrics and gynecology, or is a qualified CMHC or HIV/infectious disease practitioner or, A federally qualified Health Center (FQHC) or Rural Health Clinic (RHC).
The W-9 must also be dated within six months of the enrollment application date. 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.
It’s easy to become a Colorado Access provider. New applicants will be required to indicate whether they are enrolling temporarily due to the public health emergency or enrolling for the long-term. Temporary enrollment will end once the public health emergency ends. By adding the COVID-19 Temporary Enrollment secondary specialty to the application, providers are acknowledging that application fees, fingerprinting and site visits, which are usually required for enrollment, will be waived. Prior authorization forms should be faxed to Navitus at 855-668-8551.
Physical Therapist, Podiatrist, Psychologist) cannot be changed.
Incorrect Taxonomy Code - The NPI and taxonomy code submitted with the provider’s enrollment application must match the information on record with the National Plan and Provider … Keep reading to find out how to join our network. For example, a Pharmacy only has the option to enroll as a facility, while a Physician may enroll as either a Billing Individual, an Individual Within a Group, or an Ordering-Prescribing-Referring (OPR) Provider. Search Criteria. Our member handbook for Health First Colorado (Colorado’s Medicaid Program) members is now available.
(Income is reported to the IRS under the individual’s SSN.) Individual providers such as a billing individual, Individual within a group and ordering, prescribing and referring providers may not be enrolled as two different provider types under the same Social Security Number (SSN).