It’s easy to become a Colorado Access provider. The Centers for Medicare & Medicaid Services (CMS) sets the fee annually. A secondary question, ‘Is this entity an individual?’, must be answered ‘Yes’ when disclosing information for individual owners of the business. An SSN is required for each owner when disclosing information for individual owners of the business. What happens next? 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. Beacon credentials individual practitioners and facilities. Temporary providers must be licensed and legally authorized to practice or deliver the services for which they will file claims in the state where the services are performed and cannot be listed on the Office of Inspector General's exclusion list for Medicare/Medicaid services. Each section below represents an Enrollment Type. It’s easy to become a Colorado Access provider. Our utilization management team will work to set up a home health agency to visit the patient’s home and administer the medication. Why would you want to? Please send us the following information for each practitioner and facility that would like to be credentialed with us. Find out if you qualify and how to easily apply for Health First Colorado, Colorado's Medicaid Program. If you feel these rights have not been upheld, you can call the Behavioral Health Ombudsman at 303-866-2789, Email them at:, or go online at: Early and Periodic Screening, Diagnostic, and Treatment, Screening Brief Intervention & Referral To Treatment,, 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). Prior authorization forms should be faxed to Navitus at 855-668-8551. This act states that there are not more limits on your behavioral health benefits than your physical health benefits. Keep reading to find out how to join our network. Individuals may affiliate with multiple groups in different locations. Download an enrollment checklist based on the Enrollment Type(s) associated with the chosen Provider Type from step 1. Ensures that orders, prescriptions and referrals for Health First Colorado members are accepted and processed appropriately. 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. Demonstrate commitment to the following principles of the Medial Home model as amended by the state. OPRs are not allowed to be rendering individuals on a claim. 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. Print all results. Effective July 4, 2019, provider enrollment letters will now include the Health First Colorado ID. Before the enrollment type can be updated from OPR to IWG, providers must update their license. 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. OPR providers are not eligible to bill for services rendered. This is a requirement to participate in our networks. Need to speak to a live agent for help with your enrollment? OPR providers will not be listed as a Health First Colorado provider for member assignment or referral. Providers may affiliate via the group profile through the Provider Web Portal, or the individual will have access to make the affiliation after the enrollment type change is made. The application is reviewed by the Department's fiscal agent. Health First Colorado and CHP+ Provider Revalidation. Missing or Non-Matching Attachment Information - Information on the document(s) provided as proof of licensure, certifications, insurance, or any additional required documentation … Individuals Within a Group may affiliate with multiple groups in different locations. Medicaid Provider Location ID (aka Billing ID) per service location. 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. 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 … COVID-19 Provider Information; Access the SAVE System; Learn about the Colorado NPI Law 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. 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. Apply Now; Find a Doctor; Benefits & Services; News & Resources; About; Get Help; Search the Site; Apply now! All rights reserved. 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 Enumeration System (NPPES). Upon prior authorization approval, Navitus will notify Avella, who will fax a home health request to set up the services. 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. Health Plan Key. 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. If additional verification is needed during the screening process, the application documents can be used to expedite the enrollment application. Not all Enrollment Types are available for all Provider Types. 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… An additional question, ‘Date of Birth’ will be populated and must be answered when disclosing information for individual owners of the business. 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. This is necessary because the validity and currency of all provider licenses to perform any service must be screened. These regulations are designed to increase compliance and quality of care and to reduce fraud. Some applications may require a site visit or Department approval. The National Provider Identifier (NPI) will also continue to be included in provider enrollment letters. 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. © 2019 State of Colorado | Transparency Online | Accessibility, Coronavirus Disease 2019 (COVID-19) in Colorado: State & National Resources, Common Reasons Enrollment Applications Are Returned to Providers, A current date (within six months of the enrollment application date), Information on the account type, routing number, and account number, Signature from an authorized bank representative from the attached bank’s company. In response to provider concerns, the Department will now allow provider types 05-Physician and 26-Osteopath with training licenses to enroll as OPR providers with Health First Colorado. Thank you for your interest in becoming a PCP with Beacon Health Options. 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. Individuals should only have one enrollment. Facility and Ancillary providers, please fill out our Facility/Ancillary Provider Appendix. This updated … An additional application for any of these individual types with the same SSN will result in the application being denied as a duplicate. 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. The specific criteria for approval can be found here. If only a training license is on file, then the provider must submit a current, full license through the Provider Web Portal. 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. Individuals who are already enrolled in Health First Colorado as rendering providers are not required to enroll separately as OPR providers.