Become a Provider
Our success lies in our relationship with our providers who offer a high standard of care.
Join Our Network
Thank you for your interest in becoming a contracted provider with Colorado Access.
We have paused new provider contracting for our Child Health Plan Plus (CHP+) and Health First Colorado (Regional Accountable Entity, RAE) networks. During this pause, we are not accepting new contracts or processing new applications for these lines of business. The pause will remain in effect while we incorporate enhanced network data that will further strengthen how we align contracting decisions with member need, access, and network capacity. We do not have an end date for the pause at this time and will share updates as they become available.
This pause does not apply to Colorado Access Choice, our Marketplace plan.
The only exception to the CHP+ and RAE pause is for providers who directly deliver services Colorado Access has identified as highly needed because of documented shortages in our network. These services are listed below and apply statewide. For these services, children are ages 0 to 12 and youth are ages 13 to 21. Exceptions are limited to the following services:
- Colorado System of Care (CO-SOC) services, including Enhanced High Fidelity Wraparound, Enhanced Multisystemic Therapy, and Enhanced Functional Family Therapy
- Substance Use Disorder and behavioral health residential, partial hospitalization (PHP), or intensive outpatient (IOP) services for children and youth
- Eating disorder treatment for any age
- Behavioral health or substance use disorder services delivered directly by clinicians fluent in a language other than English or Spanish
- Behavioral health respite services for caregivers of children with complex needs
- A service delivered in a county where our most recent quarterly network adequacy review identified an access gap for that service. (primarily in the CHP+ network for rural counties) These categories and counties are reviewed and updated every quarter. If you believe your service and location may qualify, contact us and we will confirm against the current review.
No other services or specialties qualify for an exception. To be considered, the service must be a core part of your practice, delivered by staff with the specialized training or credentials it requires, and not already readily available from other contracted providers in your area. If your practice meets these requirements, please complete an application. Submitting an application does not guarantee a contract. Each application is reviewed individually against current network needs, and applications for these services may still be declined. If declined, you will receive written notice of the reason.
Submit a Provider Contract Application
If you are interested in contracting with Colorado Access and meet one of the exception criteria above, please click on the link below to complete our online provider contract application/Appendix and follow the instructions to submit the required information and copies of your W-9 and proof of professional liability Insurance coverage.
Once the application/Appendix is received, we will review your request and respond to you directly with next steps.
If you have any questions or need to report issues with your submission, please email our team at provider.contracting@coaccess.com.
Provider Contract Application/Appendix →
If you are adding a provider to an existing contract, please see below for the Clinical Staff Update Form.
Please be sure to validate your organizational and/or individual National Provider Identifier (NPI) with the state of Colorado. This is a requirement to participate in our networks. 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.
Add a New Individual Provider to Your Existing Contract
If your practice is currently contracted with us and you’d like to add a new provider to your practice, please complete a Clinical Staff Update Form.
Provider Frequently Asked Questions
No. You must be contracted as a primary care provider (PCP) in the Accountable Care Collaborative (ACC) program before they can receive attributions. You must meet specific criteria to be considered for PCP contracting and have a signed agreement with the regional organization serving your region.
All behavioral health providers must go through our credentialing process. CHP+ HMO providers must also go through our credentialing process. All providers, including behavioral health providers and PCPs, must be validated by the Department of Health Care Policy and Financing (HCPF) and enrolled as a Medicaid provider.
If you have been successfully revalidated, you do not need to do so again. Click here to learn more about validation.
No. The only exception to this would be bed-based care (inpatient, residential, acute treatment unit or intensive outpatient).
Yes, we have regularly scheduled webinar trainings.
Yes, we have regularly scheduled webinar trainings. You can also request an in-office training with your provider relations representative.
In ACC Phase II, members will be attributed to the brick and mortar service location, rather than the group Medicaid billing ID. This means that all Primary Care Providers (PCPs) must ensure they are billing HCPF utilizing site IDs and that each site is contracted with their regional organization. All claims submissions must adhere to Colorado Medicaid billing guidelines as outlined in the Billing Manuals. Specifically, claims must be submitted using the proper service location ID and address where services are rendered. For guidance on how to add a NPI for a service location, see Provider Web Portal Quick Guide: Provider Maintenance – Adding a National Provider Identifier (NPI) | Colorado Department of Health Care Policy & Financing.
The state will use four different methodologies to ensure all members are attributed to a PCP site location.
- Member selection: ACC members have the option of choosing a different PCP at any time by calling the state’s enrollment broker.
- Claims history: If an ACC member has a demonstrated claims history with a practice over the last 18 months, the system will automatically attribute the member to that location. The system first looks at paid Evaluation and Management (E&M) claims, then other types of claims are considered.
- Family connections: If member has no utilization with a PCP in the past 18 months, the system will attribute the member to the PCP with which a family member is attributed. This occurs only if the PCP is appropriate. Example: a parent will not be attributed to a child’s PCP if that PCP is a pediatrician. Family relationships will be assumed when a member shares last name, street address, city and ZIP code.
- Proximity: If neither a member nor a family member has a utilization history with a PCP, the system will determine the closest appropriate PCP within the member’s region and attribute to that location.
Using Emdeon the Payment Manager, enrolled providers can download PDF versions of Explanation of Payments (EOPs) that were previously mailed in hardcopy with a VCC or conventional check format. Please call 855-886-3863 to learn more.
Complete and submit a Clinical Staff Update Form. Note: submission of this form is to initiate the process for adding a provider and there may be additional steps required for approval to provide services to our members. Please contact your provider relations representative for the provider’s effective date.