In order to be eligible for reimbursement for services provided to Child Health Plan Plus (CHP+) members, all CHP+ providers must:
- Have an active contract with a CHP+ Managed Care Organization (MCO).
- Have a current enrollment — successfully completed enrollment or revalidation through the Colorado interChange — with Gainwell. Visit the Provider Enrollment web page to learn more.
For more information about contracting with a CHP+ MCO, please reach out to:
| CHP+ MCO | Contact Information |
|---|---|
| Colorado Access | 800-511-5010 |
| Denver Health Medical Plan | 303-602-2003 |
| Kaiser Permanente | 866-866-3951 |
| Rocky Mountain Health Plans | Western Slope providers: 970-244-7798 Front Range providers: 303-689-7372 |
CHP+ Provider Billing
CHP+ billing differs slightly from Health First Colorado. If a CHP+ member’s eligibility start date occurs prior to the member’s enrollment with a CHP+ MCO, any services provided during the retro eligibility period must be billed to the state fiscal agent Gainwell via the Colorado interChange. Pharmacy claims are submitted to Prime Therapeutics.
All CHP+ eligible members will be mandatorily enrolled into a participating CHP+ MCO on the date the member’s CHP+ eligibility determination is received from the Colorado Benefits Management System (CBMS) by the Colorado interChange. As a result, a member’s date of enrollment into an MCO may not be the same as the member’s CHP+ eligibility start date. Members will be enrolled into an MCO based in part on the county in which they live.
Providers should submit claims to the MCO once a CHP+ member is enrolled into an MCO. Providers should reference the MCO’s contracted rates and associated provider resources when submitting CHP+ claims to the MCO.
The CHP+ Fee Schedule for the pre-MCO “fee-for service" timeframe is located on the Provider Rates and Fee Schedule web page. Please reach out to your MCO for their fee schedule.
Please reference the Verifying Eligibility Quick Guide for more information about verifying CHP+ member eligibility and enrollment in the provider portal.
All CHP+ providers must be contracted with a CHP+ MCO and enrolled in the Colorado interChange to be eligible for reimbursement for services delivered to CHP+ members.
Call the Provider Services Call Center you have questions about submitting claims to the Colorado interChange. The call center is open 7 a.m. to 5 p.m., Monday through Friday. Call the Prime Therapeutics Pharmacy Call Center at 1-800-424-5725 if you have any questions about submitting pharmacy claims.
CHP+ Pharmacy
Prime Therapeutics State Government Solutions, LLC Pharmacy Call Center
Phone: 1-800-424-5725
Fax: 1-800-424-5881
Email: COProviderResponseTeam@primetherapeutics.com
State Fiscal Agent CHP+
Colorado Medical Assistance Program Fiscal Agent
Gainwell Technologies
P.O. Box 30
Denver, CO 80201
State Managed Care Network Transition
Effective July 1, 2021, all Child Health Plan Plus (CHP+) eligible members are automatically enrolled into a CHP+ Managed Care Organization (MCO). As a result, the CHP+ State Managed Care Network (SMCN) is no longer available to pay for health care services for CHP+ members delivered after June 30, 2021.