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Our Providers

We strive to provide information and resources you need to strengthen your practice and ultimately, strengthen health outcomes for patients.

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Our Plan for the End of
Continuous Coverage

In January 2020, the U.S. Department of Health and Human Services (HHS) responded to the COVID-19 pandemic by declaring a public health emergency (PHE). Congress passed legislation to ensure that anyone enrolled in Medicaid (Health First Colorado (Colorado’s Medicaid program) in Colorado), as well as children and pregnant people who were enrolled in the Children’s Health Insurance Program (Child Health Plan Plus (CHP+) in Colorado), was guaranteed to keep their health coverage during the PHE. This is the continuous coverage requirement. Congress recently passed a bill that ends the continuous coverage requirement in the spring of 2023.

New Claims/Payment System

As of November 1st, we have changed our claims system to HealthRules Payor (HRP).  This new system will make claims processing more efficient. As part of this change, we also worked with PNC Healthcare to provide new electronic payment methods through their Claim Payments & Remittances (CPR) service, powered by Echo Health, with dates of service starting Tuesday, November 1, 2022. To guarantee prompt payment, please submit your October and November claims separately when possible.

Click here to see new payment options.

If you have any questions regarding this transition, please contact your provider network services representative directly or send an email to

COVID-19 Information

We want you to know about any member benefit changes from COVID-19.

To learn more about benefits, testing, treatment, and getting health care during the COVID-19 pandemic, please visit:

Kit Carson County Expansion

Friday Health Plans (FHP) is not renewing their Child Health Plan Plus (CHP+) contract, which ends on June 30, 2022. FHP will transition out from the CHP+ program on this date. Starting July 1, 2022, we will be the new CHP+ Managed Care Organization (MCO) for Kit Carson County. Members in this county who were enrolled with FHP will move to our CHP+ MCO based on standard enrollment guidelines.

Our contracting team is working to get FHP providers contracted with us as soon as possible. To begin this process, or if you have any questions, please email us at Our provider contracting team will guide you through the application, contracting, and credentialing process. Contracting and credentialing can take 60 to 90 days. Click here to learn more about joining our provider network.

Billing and Coding Updates

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. If you submit your claims through 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.

Please send an email to your assigned provider network services representative with questions about this requirement. Please contact if you do not know your currently assigned provider network services representative.

Almost Home Inc.

Spring 2022

The Delores Project

Spring 2022

Rural Communities Research Center

Spring 2022

Adelante Familias/Forward Families

Spring 2022

Green Valley Ranch Medical Clinic & Urgent Care

Spring 2022

Community Partner- Colorado Coalition for the Medically Underserved

Winter 2022

Community Partner- Denver Housing Authority

Summer 2018

Community Partner- Global Refugee Center

Summer 2018

Integrated Care

Summer 2018

Provider Frequently Asked Questions

How do I get Synagis for my patients?

Complete Synagis prior authorization form and fax to Navitus at 855-668-8551. You will receive a fax indicating approval or denial of prior authorization determination is made. If request is approved, fax order for Synagis to Lumicera Specialty Pharmacy at 855-847-3558. 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 on your order. Upon receipt of Synagis order indicating that medication will be shipped to patient’s home, Lumicera will fax a home health request to Colorado Access utilization management (UM) team to set up the services. Our UM team will work to set up a home health agency to visit the patient’s home and administer the medication.

Is Synagis covered by Colorado Access?

Synagis is covered for eligible patients through the Colorado Access pharmacy benefit. The specific criteria for approval can be found here. Prior authorization forms should be faxed to Navitus at 855-668-8551.