For Our Providers
Congress has renewed federal funding for Children's Health Insurance Program (CHIP)
Congress has renewed federal funding for the Children's Health Insurance Program (CHIP) for six years and the President has signed the bill in to law. This means the Child Health Plan Plus (CHP+) program will continue in Colorado.
This week the Department will begin notifying CHP+ members that the program will continue. Additional information will be made available in the coming days on CO.gov/HCPF/FutureCHP.
Important Update for Regional Care Collaborative Organization (RCCO) Primary Care Medical Providers (PCMP)
Please note this only applies to current Regional Care Collaborative Organization Primary Care Medical Providers, and does not apply to behavioral health providers, Child Health Plan Plus HMO providers.
Billing and Coding Updates
We are currently seeing a sharp increase in claim denials as a result of the incorrect use of applicable modifiers with certain service codes. As a result, we want to remind you that all billed services must have an applicable modifier. Please note that many services can have more than one applicable modifier, and all must be included in order for the claim to be paid.
Please note that all modifiers and requirements are listed out in the coding manual which can be found on the Department of Health Care Policy and Financing (HCPF) website at https://www.colorado.gov/pacific/hcpf/mental-health-rate-reform-0.
If you submit your claims via a clearinghouse, please contact your clearinghouse to inquire which fields in their software to enter the modifier(s) that will interface to "Box 24D" of the CMS1500 form that we will receive.
Substance Use Disorder Services: Any substance use disorder service should be indicated with the HF modifier, which can ONLY be in the second modifier position. There must be another applicable modifier placed in the first position.
Effective Immediately: Claims with HF billed in the first position will be denied. Claims with HF in the second position and blank in the first position will also be denied.
Effective January 1, 2018: All other services must have an applicable modifier in the first position. If this is blank, claims will be denied effective January 1, 2018. Please see individual code pages for applicable modifiers related to the billed code.
A special Provider Bulletin has been released. Please click here to read it.
The majority of the information presented on this page pertains to in-network (participating) providers.
- Click here for out-of-network (non-participating) provider information.
- If you are not a Colorado Access provider, and would like to be, click here
Let us know if you have provider-based questions. Our staff is happy to help because we're all working to provide the best health care to Coloradans.
We are committed to making continuous improvements, including new enhancements to the provider portal. If you have any feedback, questions or suggestions, please contact your assigned Provider Relations representative
The following online tools and clinic reports open in a new window and require a provider logon ID. If you do not have a provider logon ID, click here for a Provider Logon ID Request Form.
NOTE: Three (3) consecutive, incorrect logon attempts (even days or weeks apart) will lock your access. To avoid this, if you've had two (2) failed attempts to logon, click on the "forgot password" and follow the prompts for changing your password.
For the best web experience, please use Internet Explorer to browse this site.
|Tool Kit||PCP Reports|
|Claim Status||Regional Care Collaborative Organization (RCCO) Enrollment Report|
|Eligibility - Providers utilizing the Colorado Access Provider Toolkit to check eligibility after-hours or on the weekends might encounter an issue where they receive a message "No Member Found", click here for more information||CHP+ offered by Colorado Access|
|CCAR||CHP+ State Managed Care Network|
|Colorado Access File Share|
|Behavioral Care Fee Schedule|
|Service Coordination Plan (SCP)|