Which billing manual should I use based on my provider type?
- General Provider Information
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- General Provider Information (7/23)
- Managed Care Encounters Reporting Guide
- Appendices
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- 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 (7/23)
- Appendix S - RA Expenditure Reason Codes (12/18)
- Appendix T - Capitated Behavioral Health Program - please review Appendix C of the State Behavioral Health Services Billing 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- Appendix U - Forms - No longer active, please see Forms button at bottom of page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- Appendix W - No longer active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 (10/23)
- 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 (9/23)
- CMS 1500 (Professional)
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- Ambulatory Surgery Centers (ASC) (5/23)
- Audiology (5/23)
- Behavioral Health Secure Transportation (6/23)
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (7/23)
- Early Intervention Program (12/22)
- Family Planning Benefit Expansion for Special Populations (8/23)
- Gender-Affirming Care Services (8/23)
- Immunization Benefits (8/23)
- Laboratory Services (8/23)
- Managed Care (10/22)
- Medical and Surgical Services (4/23)
- Nurse Home Visitor Program (NHVP) (9/20)
- Obstetrical Care (9/23)
- Outpatient Behavioral Health FFS (3/23)
- Outpatient Imaging and Radiology (8/23)
- Program of All-Inclusive Care for the Elderly (PACE) (4/21)
- Pediatric Behavioral Therapy (1/23)
- Pediatric Personal Care (12/20)
- Pharmacist Services Billing Manual (9/23)
- Physical and Occupational Therapy (PT/OT) (9/23)
- Physician-Administered Drugs (4/23)
- Prenatal Plus Program (9/20)
- Qualified Residential Treatment Program (QRTP) (4/23)
- Residential Child Care Facility (RCCF) (7/22)
- School Health Services (SHS) (8/22)
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) (3/23)
- Speech Therapy (9/23)
- Targeted Case Management - Transition Coordination (02/22)
- Telemedicine (7/23)
- Transportation
- Vision and Eyewear (8/21)
- Dental
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DentaQuest Colorado Medicaid and CHP+ Dental Program Providers (10/22)
(The above link will redirect to the DentaQuest Colorado Providers page.) - HCBS
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- HCBS - Adult - BI, CMHS, and EBD (4/23)
- HCBS - Complementary and Integrative Health (CIH) (9/23)
- HCBS - Children's - CHCBS and CLLI (4/23)
- HCBS - Children's Habilitation Residential Program (CHRP) Waiver Program (7/23)
- HCBS for Persons with Intellectual and/or Developmental Disabilities Waiver Programs (7/23)
- Pharmacy
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- Pharmacy Billing Manual (9/23)
- Pharmacist Services Billing Manual (9/23)
- 340B Policy Manual (6/23)
- UB-04 (Institutional)
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- Dialysis Billing Manual (9/23)
- Federally Qualified Health Center/Rural Health Center (FQHC/RHC) (8/22)
- Home Health Billing Manual (10/22)
- Hospice Billing Manual (9/23)
- Indian Health Services (IHS) (3/23)
- Inpatient/Outpatient (IP/OP) Billing Manual (9/23)
- Nursing Facility Billing Manual (4/23)
- Private Duty Nursing Billing Manual (7/22)
- Psychiatric Residential Treatment Facilities (PRTF) Billing Manual (4/23)
National Billing Guidelines
Provider Type-specific Information
Home and Community-Based Services (HCBS)
- Alternative Care Facilities (ACF)
- Benefits Utilization System (BUS) updates
- Critical Incident Reporting for HCBS Waivers
- Electronic Visit Verification (EVV)
- HCBS Critical Incident Reporting (CIR) updates
- HCBS Settings Final Rule
- HCBS Public Comment Opportunities
- Home Modification Benefit
- Long-Term Services and Supports Programs
- LTSS Case Management Tools Page
- Case Management Agencies
- Waiver Charts
Residential and Inpatient Substance Use Disorder (SUD) Service Providers
Policy Statements
- Policy Statement: Billing Health First Colorado Members for Services
- Policy Statement: Charging Health First Colorado Members For Missed Appointments
- Policy Statement: Dismissing Health First Colorado Members From a Provider's Practice
- Policy Statement: Member Co-Pays and Provision of Services
- Policy Statement: Billing for Individuals who Receive Retroactive Health First Colorado Eligibility