Provider Resources

Per member.

No. Providers must be contracted as a primary care provider (PCP) in the Accountable Care Collaborative (ACC) program before they can receive attributions. Providers must meet specific criteria to be considered for PCP contracting and have a signed agreement with the regional organization serving their 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, these sessions will be available in a primary care setting without a covered diagnosis. Sessions provided and billed by a behavioral health practitioner to Colorado Access can also be provided without a covered diagnosis.

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.