colorado medicaid provider enrollment

The National Provider Identifier (NPI) will also continue to be included in provider enrollment letters.

COVID-19 Temporary Enrollment - Add this secondary specialty to the application if the provider is only enrolling to provider services during the public health emergency. (36), Transportation (73) (Specialties 326 and 525), Psychiatric Residential Treatment Facility (30), Transportation (13) (Specialties 086, 124 and 324), Federally Qualified Health Center (FQHC) (32), Non-Physician Practitioner - Individual (24), Certified Registered Nurse Anesthetist (CRNA) (40). Training licenses are not accepted for Individual Within a Group (IWG) or billing individual enrollments; full licenses are required. Please be sure to validate your organizational and/or individual National Provider Identifier (NPI) with the state of Colorado. Prior authorization forms should be faxed to Navitus at 855-668-8551. Need to speak to a live agent for help with your enrollment? The specific criteria for approval can be found here. It’s easy to become a Colorado Access provider. (Income is reported to the IRS under the individual’s SSN.) In addition to selecting a provider type and primary specialty, each applying provider will need to add one of the following secondary specialties to their application: This applies only to provider types for which application fees, fingerprinting and/or site visits are required, including: For providers choosing to enroll temporarily: The Affordable Care Act (ACA) requires certain providers to remit an application fee. Thank you for submitting an enrollment application. This is a requirement to participate in our networks. 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. If only a training license is on file, then the provider must submit a current, full license through the Provider Web Portal. Providers are encouraged to review the information below for faster approval. 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.

This act states that there are not more limits on your behavioral health benefits than your physical health benefits. 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 rule CCR 2505-10 8.100  by enrolling. we understand your time is valuable and we respect your expertise, which is why we ensure: Provider relations representatives provide quick responses to your questions and concerns, Your claims are processed and paid quickly. 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. 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. 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: Be enrolled as a provider in the Colorado Medicaid program; Be either: Certified by the state as provider in the Medicaid … What happens next? Thank you for your interest in becoming a PCP with Beacon Health Options. Effective July 4, 2019, provider enrollment letters will now include the Health First Colorado ID. If an enrolled individual with an SSN wants to change provider types, the existing enrollment needs to be disenrolled, the affiliations ended and a new application completed. This is necessary because the validity and currency of all provider licenses to perform any service must be screened. For more information about participating in Health First Colorado (Colorado’s Medicaid Program) or the validation or revalidation process, visit the website for the Department of Health Care Policy & Financing.

IMPORTANT: Select the Enrollment Type on the application as indicated below. An additional application for any of these individual types with the same SSN will result in the application being denied as a duplicate. Providers enrolling with a training license must use taxonomy code 390200000X on the enrollment application to indicate the training license. The application is reviewed by the Department's fiscal agent. IWGs do not receive direct payment for services rendered. Demonstrate commitment to the following principles of the Medial Home model as amended by the state. OPR providers will not be listed as a Health First Colorado provider for member assignment or referral. 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. This updated … 7500 Security Boulevard, Baltimore, MD 21244 Download an enrollment checklist based on the Enrollment Type(s) associated with the chosen Provider Type from step 1. If you're a current member and need to see a doctor, dentist, or other medical provider please see our Find a Doctor page.

As the Administrative Service Organization for Health Colorado (Region 4) joining the Beacon network will allow you to serve Health First Colorado Members throughout the region. 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. All rights reserved.

Print all results. Physicians, other practitioners and facilities who render services to Health First Colorado members based on the order, prescription or referral of an OPR provider will not be paid for such items or services unless the OPR provider is enrolled in Health First Colorado and the National Provider Identifier (NPI) number is included on the claim submitted to Health First Colorado. 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. Members are protected under the Federal Mental Health Parity and Addiction Equity Act (MHPAEA). Our member handbook for Health First Colorado (Colorado’s Medicaid Program) members is now available. © 2019 State of Colorado | Transparency Online | Accessibility, this link will open the enrollment checklist for atypical HCBS providers in a new window, this link will open the enrollment checklist for atypical non-HCBS providers in a new window, this link will open the enrollment checklist for facility providers in a new window, this link will open the enrollment checklist for group providers in a new window, this link will open the enrollment checklist for individual within a group providers in a new window, this link will open the enrollment checklist for billing individual providers in a new window, this link will open the enrollment checklist for OPR providers in a new window, Coronavirus Disease 2019 (COVID-19) in Colorado: State & National Resources, Billing Individual vs Individual within a Group, Administrative Services Organization (ASO)(81), Case Management Agencies (including Community Centered Boards (CCB) and Intensive Case Managers) (11), Health Maintenance Organization (HMO) (23), Home and Community Based Service (HCBS) provider (This includes all waiver providers i.e. Incomplete information will result in a delayed response. Before the enrollment type can be updated from OPR to IWG, providers must update their license.

Be licensed as a MD, DO or NP provider by the Colorado Medical Board of Nursing to practice in the state of Colorado; Act as the dedicated source of primary care for members and be capable of delivering the majority of the Member’s comprehensive primary, preventive and sick medical care; and. Individuals may affiliate with multiple groups in different locations. Learn more about the app. Does not obligate providers to see Health First Colorado members. Our utilization management team will work to set up a home health agency to visit the patient’s home and administer the medication. Temporary providers will be able to submit claims, maintain access to program tools and finalize billing for up to 6 months following the public health emergency end date for dates of services within the emergency designation date spans. The Enrollment Type categorizes provider types to help identify additional enrollment requirements. We are currently adding new providers to our networks. Refer to the drop-down section further down on this page, titled “New Provider Specialties for COVID-19 Long-Term and Temporary Enrollment,” for further details. W-9 - The Organization in the application needs to match the Tax Classification on the W-9. Once the updates are submitted, providers must call the Provider Services Call Center at 1-844-235-2387 to request the change from IWG to BI. 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). 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. New applications and enrollment updates are currently being processed by the Department's fiscal agent within 30 business days on average. If you are interested in contracting with Colorado Access please complete a Provider Contract Appendix and return it along with copies of your W-9 and proof of Professional Liability Insurance coverage and send them to our provider contracting team at provider.contracting@coaccess.com Once the Appendix is received, we will review your request within 30 business days, and will respond to you directly. COVID-19 Long Term Enrollment - Add this secondary specialty to the application if the provider intends to continue providing services beyond the public health emergency. © 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. Health First Colorado (Colorado's Medicaid Program) is public health insurance for Coloradans who qualify. In response to provider suggestions, the Department and DXC have updated provider enrollment letters. Synagis is covered for eligible patients through the Colorado Access pharmacy benefit. Each section below represents an Enrollment Type. Providers are encouraged to attach IRS documentation for groups and facilities or Atypical providers that includes the legal name and tax identification number with their Health First Colorado (Colorado’s Medicaid Program) enrollment application.

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