Provider FAQs

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. You can also request an in-office training with your provider relations representative.

Yes, we have regularly scheduled webinar trainings.

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.

We’re glad you’re interested in becoming a contracted provider! Please visit our Become a Provider page for specific information on how to become a Colorado Access provider.

The default payment method is through a Virtual Credit Card (VCC). Click here for information on other payment options and how to request a change.

Thank you for keeping us updated regarding address changes! Complete and submit a Provider Address Change Form. Note: when changing your remit address, please include a copy of your current W9.

The first step is to complete and submit a Provider Logon ID Request Form. If you are having problems with your username/password, please email ProviderNetworkServices@coaccess.com. Note: you must have the most current version of Adobe to complete and submit this form electronically through the website.

In order to be reimbursed for your services from a regional organization, you must have contracts with regions in which your patients are assigned.

Members will not be attributed to behavioral health providers. Members will be attributed to the region in which their primary care provider (PCP) is located, which will determine their regional organization. You will need to be contracted with the members’ regional organization to be reimbursed by the regional organization.

You must have a contract with each regional organization where you have a location. You also need a Medicaid site ID. You will bill the Department of Health Care Policy & Financing (HCPF) with that site ID. If you have questions, please call us Monday through Friday from 8:00 a.m. to 5:00 p.m.

We’re sorry you’re having issues with your contract and we’d be happy to help. Please contact your provider relations representative. You may also email us at ProviderNetworkServices@coaccess.com.

Provider-carrier disputes must be submitted within 60 calendar days from the date of the incident on which the dispute is based, or the explanation of payment on which the claim in dispute appears. You may only submit one provider-carrier dispute per each specific administrative, payment, or other dispute at issue.

How to submit a provider-carrier dispute:

• In the provider portal: Once you have identified the claim, select “File Claim Appeal.” A form will appear; attach your supporting documentation.
• By mail: Mail a letter or provider-carrier dispute form with all necessary information to:

Provider-Carrier Disputes

P.O. Box 17189

Denver, CO 80217-0189

• • • • Please include the claim appeal form. You can find it on our website at coaccess.com/providers/forms.

If you disagree with the way we processed a claim, you should submit a claim appeal (provider carrier dispute) form and all supporting documents in writing to:

Appeals and Adjustments
Colorado Access
PO Box 17189

Denver, CO 80217-0189
Please note: An incomplete form or incomplete documentation may delay the appeal or result in a denial. If you have questions about an appeal, or would like to learn the status of your appeal, please call us. For additional information, please review the “Provider Carrier Disputes” (Claim Appeal) section of your provider manual.

Yes, they can.

Yes, prior authorization is required for certain procedures. To see services that require prior authorization, please consult our Master Authorization List on the Provider Toolkit.

For applicable provider groups doing integrated care, the first six sessions billed using short-term behavioral health codes (90791, 90792, 90832, 90834, 90837, 90846, and 90847) will now be sent to Health First Colorado as fee-for-service claims instead of the being sent to the Behavioral Health Organization (BHO) for payment.  After six sessions, providers must receive a prior authorization from their regional organization to have additional short-term behavioral health services paid under the capitated behavioral health benefit.

We request that our network providers adhere to state and federal standards for appointment availability for members. If you are unable to provide an appointment within the required timeframes, listed below, please refer the member to our customer service department for assistance finding the care they need in a timely manner.

On the date of service, please check the state web portal to confirm eligibility. If the state web portal is showing that a person is eligible for Medicaid or CHP+ on the date of service, a copy of that printout can be used as proof of eligibility regardless of future retro-enrollment activities. You can also verify member eligibility in our provider portal.

• Attribution criteria: You must be contracted as a primary care provider (PCP) in the Accountable Care Collaborative (ACC) program before members can be attributed to your practice. You must meet specific criteria to be considered for PCP contracting, and have a signed agreement with the regional organization you wish to contract with. All claims must be submitted using the proper service location ID and address where services are rendered. Click here to learn more about adding a National Provider Identifier (NPI) for a service location.
  • Members will get a letter notifying them about their PCP assignment, how to change their PCP, and who their regional organization is based on their PCP assignment. This information is also in their member handbook.
  • Members may be assigned to a PCP based on claims history or requests. They are not required to only get care from their attributed site. Members can choose a different PCP by calling the state’s enrollment broker at 888-367-6557 (toll-free). Learn more here.
• Behavioral health providers: Members will be attributed to the region in which their PCP is located, which will determine their regional organization. They will not be attributed to behavioral health providers. You will need to be contracted with the members’ regional organization to be reimbursed by the regional organization. You will get paid by submitting your claims to the regional organization your member is assigned.
• Physical health providers: You must have a contract with each regional organization where you have a location, and a Medicaid site ID to bill the Department of Health Care Policy & Financing (HCPF) with. Physical health claims will continue to be paid by the state. If you are a PCP contracted with us who received medical home payments from us (instead of the state), we’ll be sending those through our claims processing vendor, Change Health.

An Episode is currently defined as a 12-month period beginning with the first date of service.

Applicable provider types can bill six sessions using applicable codes within a 12-month period without a covered diagnosis. They must meet medical necessity, be provided by a Medicaid enrolled masters level or higher licensed behavioral health provider, follow CPT coding practices and documentation requirements, and be available in a primary care setting.

Federal regulations by the Centers for Medicare & Medicaid Services (CMS) require that all Medicare, Medicaid and CHP+ providers undergo enhanced screening and revalidation.

For more information, click here.

This depends on the type of coverage the member has:

• For members of Child Health Plan Plus (CHP+) offered by Colorado Access, refer to the Members Benefits Handbook or call us at 800-511-5010 Monday through Friday from 8 a.m. to 5 p.m.
• For Health First Colorado, visit the Health First Colorado (Colorado’s Medicaid Program) website or call us at 800-511-5010 Monday through Friday from 8 a.m. to 5 p.m.

To determine whether a code requires prior authorization for either Medicaid or CHP+ members, please consult our Master Authorization List on the Provider Toolkit.