Billing Manuals

Which billing manual should I use based on my provider type?

General Provider Information

• General Provider Information (2/23)

Managed Care Encounters Reporting Guide

• Managed Care Encounters Reporting Guide (3/23)

Appendices

• Appendix A - Colorado Department of Health Care Policy and Financing (6/22)
• Appendix B - Colorado Medical Assistance Program Fiscal Agent (6/22)
• Appendix C - Prior Authorization and Review Agencies (6/22)
• Appendix D - Programs, Services and Authorizing Agencies (6/22)
• Appendix E - County Departments of Human and Social Services (2/19)
• Appendix F - Border Towns (6/22)
• Appendix G -Outpatient Hospital Unbundled Durable Medical Equipment Codes (1/23)
• Appendix I - Provider Participation Agreement (6/22)
• Appendix M - Procedures Requiring Prior Authorization (4/19) Review the Health First Colorado fee schedule to see if a PAR is required for the procedure code.
• Appendix N - Prior Authorization Request Denial Reasons (5/17)
• Appendix O - EAPG Inpatient Only List (1/23)
• Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criteria (2/19)
• Appendix Q - Revenue Codes (7/21)
• Appendix R - Remittance Advice (RA) Messages (2/23)
• Appendix S - RA Expenditure Reason Codes (12/18)
• Appendix T - Capitated Behavioral Health Program - please review Appendix C of the Uniform Services Coding Manual found on the Accountable Care Collaborative Phase II - Provider and Stakeholder Resource Center under Behavioral Health Services.
• Appendix U - Forms - No longer active, please see Forms button at bottom of page
• Appendix V -Terms, Acronyms and Abbreviations (6/18)
• Appendix W - No longer active
• Appendix X - HCPCS and NDC Crosswalk for Billing Physician-Administered Drugs (3/23)
• Appendix Y - Physician Administered Drug Medical Benefit Prior Authorization Procedures and Criteria  (12/21) (Located under Fee for Service Physician Administered Drugs dropdown menu)
• Appendix Z - Outpatient Hospital Specialty Drugs (12/22)