Claims

Submit, File, Track, and Get Paid: Four Steps to Claims Success

Helping to improve the lives of Coloradans is important, and so is receiving timely payment for the services you provide. Your time is valuable, which is why we strive to make the claims process as easy and efficient as possible for our providers.

 1. Submit Your Claim
If you are a behavioral health or CHP+ HMO provider, you may submit claims using one of the following methods:

• Electronic Submission (Preferred): Through one of the approved EDI clearinghouses (see the electronic claims section for the list).
• Paper Submission: Mail claims to:

• Direct Data Entry (DDE): Instead of mailing a paper claim, providers may enter claims directly through the online portal, which submits claims electronically. To enroll, visit: portal.smartdatastream.us.

You should submit all Medicaid physical health claims directly to the state through the Health First Colorado (Colorado’s Medicaid program) Provider Web Portal. Click here to read more about that process. 

2. File Within Timely Filing Limits
Be sure to file claims within the timely filing limit, which is 365 days from the date of service or within the time limit specified in your contract.

 3. Track Claim Status
You can check the status of a Colorado Access claim through our provider portal.

4. Choose Your Payment Option
Be sure to choose a payment option for how you want to receive your payment. You may choose between an electronic fund transfer (EFT) payment, a Virtual Credit Card (VCC) (the default option if you don’t choose another option) or a paper check. Click here for information on other payment options and how to request a change.

If you have additional questions about the claims process, please visit the FAQ page or contact us for additional assistance.

Payment Options for Providers

There are three payment options from which you may choose:

• An electronic fund transfer (EFT) payment, which is the easiest, quickest method
• A Virtual Credit Card (VCC), which is the default option if you don’t choose another option
• A paper check

We encourage you to take action and choose your preferred payment option. Click here for information on other payment options and how to request a change.

Filing a Provider Carrier Dispute (Claim Appeal)

In accordance with Division of Insurance regulations, we require provider-carrier disputes to be submitted in writing. Information may be submitted in a brief letter in the provider portal, an email or, for claims appeals, on the Colorado Access provider-carrier dispute form located on our website here.

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

Lien or Subrogation Information

If you are an attorney or insurance company requesting a lien or subrogation for claims paid for a member related to an accident, please submit a letter of representation and a HIPAA release form signed by the member to legal@coaccess.com.

Electronic Claims

Submitting your claims to us through a clearinghouse is a quick and efficient method. We receive claims directly from the following clearinghouses:

EDI Clearinghouses

• ClaimRemedi
• Change Healthcare (formerly Emdeon)
• HealthFusion
• MedAssets
• Office Ally
• Optum
• Practice Insight
• Relay Health
• SSI Group
• Zirmed
• Availity (Payer ID: coacc)
• Experian

Please contact your preferred clearinghouse directly to receive the appropriate payer ID required to submit claims. If you have questions about electronic claim submissions, please email edi_coordinator@coaccess.com. You can also find more information about claims in our FAQ.