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Children's Habilitation Residential Program (CHRP) Waiver Program Billing Manual

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Overview

Home and Community-Based Services (HCBS) are certain Health First Colorado (Colorado's Medicaid program) benefits available to members in their homes and communities as an alternative to institutional care. HCBS programs for persons with developmental disabilities include the Children's Habilitation Residential Program (HCBS-CHRP).

Waiver programs provide additional Health First Colorado benefits to specific populations who meet special eligibility criteria.

Level of care determinations are made annually by the case management agencies (Community Centered Boards). Members must meet financial, medical, and program criteria to access services under a waiver. The applicant must be at risk of placement in a nursing facility, hospital, or ICF/IID (intermediate care facility for Individuals with Intellectual Disabilities). To utilize waiver benefits, members must be willing to receive services in their homes or communities. A member who receives services through a waiver is also eligible for all basic Health First Colorado covered services except nursing facility and long-term hospital care.

Applicants may apply for more than one (1) waiver but may only receive services through one (1) waiver at a time.

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Prior Authorization Requests (PARs)

All HCBS services require prior authorization before they can be reimbursed by Health First Colorado. Community Centered Board (CCB) case managers complete the Prior Authorization Requests for their specific programs according to instructions published in the regulations for the Department of Health Care Policy & Financing (the Department).

The CCB's responsibilities include, but are not limited to:

  • Informing members and/or legal guardian of the eligibility process
  • Submitting a copy of the approved Enrollment Form to the County department of human/social services for a Health First Colorado member identification number
  • Developing the appropriate Prior Authorization Request of services and projected costs for approval
  • As the authorizing agent, submitting the prior authorization information to the fiscal agent. Refer to Appendix D located on the Billing Manuals web page under the Appendices drop-down for a list of authorizing agents.
  • Assessing the member's health and social needs.
  • Arranging for face-to-face contact with the member within 30 calendar days of receipt of the referral
  • Monitoring and evaluating services
  • Reassessing each member
  • Demonstrating continued cost-effectiveness whenever services increase or decrease

Approval of prior authorization does not guarantee payment and does not serve as a timely filing waiver. Prior authorization only assures that the approved service is a medical necessity and is considered a benefit of Health First Colorado. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g., timely filing, provider information completed appropriately, required attachments included, etc.) before payment can be made.

Prior approvals must be completed thoroughly and accurately. If an error is noted on an approved request, it should be brought to the attention of the member's case manager for corrections. Procedure codes, quantities, etc., may be changed or entered by the member's case manager.

The authorizing Community Centered Board is responsible for timely submission and distribution of copies of approvals to agencies and providers.

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PAR Submission

The HCBS-CHRP Pars are electronically submitted by case managers via the Bridge, which directly interfaces with the Colorado interChange. Case Managers can access the Bridge via the Medicaid Enterprise User Provisioning System (MEUPS).

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Claim Submission

Submission of claims for services rendered must not be duplicative. Duplicate claims are any claims paid across more than one claim number for the same beneficiary, date, procedure code and service state by the same provider. Duplicate claims can include different procedure codes but with overlapping service definitions. Duplicates claims also include a single provider offering more than one service simultaneously. All overlapping services rendered and subsequent billing claims must have supporting documentation that clearly identifies the necessity and non-duplication of overlapping services to verify these services were provided separately and independently of one another.

Refer to the service definitions on the Colorado Code of Regulations website to identify if claims are duplicative. Refer to the provider specialty code enrollment requirements on the HCBS Provider Specialty Code List web page to identify services that must be provided by an individual provider.

In any instance in which duplicate billings result in Medicaid reimbursement, a recovery shall be made by the Department against the provider.

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down menu for general billing information.

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Children's Habilitation Residential Program (CHRP)

  • HCBS-CHRP is a residential service and support program for children and youth from birth through age 20. HCBS-CHRP provides services for children and youth who have an intellectual or developmental disability and extraordinary needs that put them in at risk of, or in need of, out-of-home placement in a nursing facility, hospital, or ICF/IID.

The waiver provides support for eligible children who:

  • May require added support as they transition back to the family home from a foster care or residential setting.
  • May require services to support their families in remaining in the family home.
  • Have an intellectual or developmental disability or developmental delay if under age five (5) and have intensive behavioral and/or medical support needs that put them at risk or in need of out-of-home placement.
  • Are willing to receive services in their homes or communities.

The waiver is designed to assist children/youth to acquire, retain, and/or improve self-help, socialization, and adaptive skills necessary to live in the community with a plan to include services. Enrollment into the HCBS-CHRP waiver occurs through area Community Centered Boards.

The following services are provided through CHRP when deemed appropriate and adequate by the child/youth's physician and they are to be provided in the community, as available:

  • Community Connector
  • Habilitation (Residential 24-hour support)
  • Respite
  • Hippotherapy
  • Massage Therapy
  • Movement Therapy
  • Child and Youth Mentorship
  • Wraparound Services

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CHRP Procedure Code Table

Providers may bill the following procedure codes for CHRP services:

Children's Habilitation Residential Program (CHRP)
DescriptionProcedure CodeModifiers
Specialty 883: Community Connector
Community Connector - Outside Denver CountyH2021U9
Community Connector – Denver CountyH2021U9, HX
Community Connector Parental Provision - Outside Denver CountyH2021U9, HA
Community Connector Parental Provision – Denver CountyH2021U9, HA, HX
Specialty 884: Foster Home
Foster Home Level 1 - Outside Denver CountyH0041U9
Foster Home Level 1 – Denver CountyH0041U9, HX
Foster Home Level 2 - Outside Denver CountyH0041U9, 22
Foster Home Level 2 – Denver CountyH0041U9, 22, HX
Foster Home Level 3 - Outside Denver CountyH0041U9, TF
Foster Home Level 3 – Denver CountyH0041U9,TF, HX
Foster Home Level 4 - Outside Denver CountyH0041U9, TF, 22
Foster Home Level 4 – Denver CountyH0041U9, TF,22, HX
Foster Home Level 5 - Outside Denver CountyH0041U9, TG
Foster Home Level 5 – Denver CountyH0041U9, TG, HX
Foster Home Level 6 - Outside Denver CountyH0041U9, TG, 22
Foster Home Level 6 – Denver CountyH0041U9, TG, 22, HX
Foster Home Level 7H0041U9, HA, TG, HK
Specialty 884: Habilitation - Group Home
Group Home Level 1T2016U9
Group Home Level 2T2016U9, 22
Group Home Level 3T2016U9, TF
Group Home Level 4T2016U9, TF, 22
Group Home Level 5T2016U9, TG
Group Home Level 6T2016U9, TG, 22
Group Home Level 7T2016U9, HA, TT, TG
Specialty 884: Residential Child Care Facility
Residential Child Care Facility Level 1 (Per Diem)T2016U9, HA
Residential Child Care Facility Level 2 (Per Diem)T2016U9, HA, TJ
Residential Child Care Facility Level 3 (Per Diem)T2016U9, HA, TF
Residential Child Care Facility Level 4 (Per Diem)T2016U9, HA, TG
Residential Child Care Facility Level 5 (Per Diem)T2016U9, HA, TT
Residential Child Care Facility Level 6 (Per Diem)T2016U9, HA, 22

Specialty 741: Hippotherapy

Services removed from the CHRP waiver effective July 1, 2024.

Refer to the Physical and Occupational Therapy Billing Manual or Speech Therapy Billing Manual for State Plan Hippotherapy.

Specialty 743: Movement Therapy
Movement Therapy-BachelorsG0176U9
Movement Therapy-MastersG0176U9,22
Specialty 742: Massage Therapy
Massage Therapy97124U9
Specialty 885: Respite
Respite - in the Family Home/15-minute increments – Outside Denver CountyS5150U9, HA
Respite - in the Family Home/15-minute increments – Denver CountyS5150U9, HA, HX
Respite - in the Family Home/Per Diem – Outside Denver CountyS5151U9, HA
Respite - in the Family Home/Per Diem – Denver CountyS5150U9, HI
Specialty 885: Respite - Residential Settings
Respite - in the Family Home/15-minute incrementsS5150U9, HI
Respite - in the Family Home/Per DiemS5151U9, HI
Specialty 615: Skilled Respite
Skilled CNA (4 hours or less) - Outside Denver CountyT1005U9
Skilled CNA (4 hours or less) - Denver CountyT1005U9, HX
Skilled RN, LPN (4 hours or less) - Outside Denver CountyT1005U9, TD
Skilled RN, LPN (4 hours or less) - Denver CountyT1005U9, TD, HX
Skilled CNA (4 hours or more) - Outside Denver CountyS9125U9
Skilled CNA (4 hours or more) - Denver CountyS9125U9 HX
Skilled RN, LPN (4 hours or more) - Outside Denver CountyS9125U9, TD
Skilled RN, LPN (4 hours or more) - Denver CountyS9125U9, TD, HX
Specialty 882: CHRP Youth Mentorship-CES/CHRP Therapeutic Respite
Skilled Therapeutic (4 hours or less) - Outside Denver CountyT1005U9, HA
Skilled Therapeutic (4 hours or less) - Denver CountyT1005U9, HA, HX
Skilled Therapeutic (4 hours or more) - Outside Denver CountyS9125U9, HA
Skilled Therapeutic (4 hours or more) - Denver CountyS9125U9, HA, HX
Child and Youth Mentorship (formerly “In Home Services”)H2021U9, HA, HM
Specialty 886: Wraparound
Same code may be billed for either Transition or Intensive Support Services
Wraparound PlanH2021U9, HA, TL
Prevention and MonitoringH2021U9, HA, HN

 

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Paper Claim Reference Table

The following paper form reference table gives required and/or conditional fields for the paper CMS 1500 claim form for CHRP claims:

CMS Field Number and LabelField is?Instructions
1. Insurance TypeRequiredPlace an "X" in the box marked as Medicaid.
1a. Insured's ID NumberRequiredEnter the member's Health First Colorado seven-digit ID number as it appears on the Health First Colorado Identification card. Example: A123456.
2. Patient's NameRequiredEnter the member's last name, first name, and middle initial.
3. Patient's Date of Birth/SexRequiredEnter the member's birth date using two digits for the month, two digits for the date, and two digits for the year. Example: 070114 for July 1, 2014.

Place an "X" in the appropriate box to indicate the sex of the member.
4. Insured's NameNot required 
5. Patient's AddressNot Required 
6. Client Relationship to InsuredNot Required 
7. Insured's AddressNot Required 
8. Reserved for NUCC UseNot Required 
9. Other Insured's NameNot Required 
9a. Other Insured's Policy or Group NumberNot Required 
9b. Reserved for NUCC Use  
9c. Reserved for NUCC Use  
9d. Insurance Plan or Program NameNot Required 
10a-c. Is patient's condition related to?Not Required 
10d. Reserved for Local Use  
11. Insured's Policy, Group or FECA NumberNot Required 
11a. Insured's Date of Birth, SexNot Required 
11b. Other Claim IDNot Required 
11c. Insurance Plan Name or Program NameNot Required 
11d. Is there another Health Benefit Plan?Not Required 
12. Patient's or Authorized Person's signatureRequiredEnter "Signature on File", "SOF", or legal signature. If there is no signature on file, leave blank or enter "No Signature on File".

Enter the date the claim form was signed.
13. Insured's or Authorized Person's SignatureNot Required 
14. Date of Current Illness Injury or PregnancyNot Required 
15. Other DateNot Required 
16. Date Patient Unable to Work in Current OccupationNot Required 
17. Name of Referring PhysicianConditional 
18. Hospitalization Dates Related to Current ServiceNot Required 
19. Additional Claim InformationConditional 
20. Outside Lab?
$ Charges
Not Required 
21. Diagnosis or Nature of Illness or InjuryRequiredEnter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition.

Enter applicable ICD-10 indicator.

HCBS
CHRP may use R69
22. Medicaid Resubmission CodeConditionalList the original reference number for resubmitted claims.

When resubmitting a claim, enter the appropriate bill frequency code in the left- hand side of the field.
7 - Replacement of prior claim
8 - Void/Cancel of prior claim
This field is not intended for use for original claim submissions.
23. Prior AuthorizationNot RequiredHCBS
Leave Blank
24. Claim Line DetailInformationThe paper claim form allows entry of up to six detailed billing lines. Fields 24A through 24J apply to each billed line.

Do not enter more than six lines of information on the paper claim. If more than six lines of information are entered, the additional lines will not be entered for processing.

Each claim form must be fully completed (totaled).

Do not file continuation claims (e.g., Page 1 of 2).
24A. Dates of ServiceRequired

The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. Enter the date of service using two digits for the month, two digits for the date and two digits for the year. Example: 010116 for January 1, 2016.

FromTo
010119   

or

FromTo
010119010119

Span dates of service

FromTo
010119013119

Practitioner claims must be consecutive days.
Single Date of Service: Enter the six digit date of service in the "From" field. Completion of the "To field is not required. Do not spread the date entry across the two fields.

Span billing: permissible if the same service (same procedure code) is provided on consecutive dates.

24B. Place of ServiceRequired

Enter the Place of Service (POS) code that describes the location where services were rendered. Health First Colorado accepts the CMS place of service codes.

03School
11Office
12Home
34Hospice

 

Note: Use POS Code 12 (Home) for Foster Home, Group Home and Respite. Use ether POS 11 (Office) or POS 11 (Home) where applicable for all other services.

24C. EMGNot Required 
24D. Procedures, Services, or SuppliesRequired

Enter the HCPCS procedure code that specifically describes the service for which payment is requested.

HCBS

Refer to the CHRP Rate Schedules located on the Rates and Fee Schedule web page.

24D. ModifierRequired

Enter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form.

HCBS

Refer to the CHRP Rate Schedules located on the Rates and Fee Schedule web page.

24E. Diagnosis PointerRequiredEnter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis.

At least one diagnosis code reference letter must be entered.

When multiple services are performed, the primary reference letter for each service should be listed first, other applicable services should follow.

This field allows for the entry of 4 characters in the unshaded area.
24F. $ ChargesRequiredEnter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.

Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one procedure from the same group is billed, special multiple pricing rules apply.

The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed.

Submitted charges cannot be more than charges made to non-Health First Colorado covered individuals for the same service.

Do not deduct Health First Colorado co-pay or commercial insurance payments from the usual and customary charges.
24G. Days or UnitsRequiredEnter the number of services provided for each procedure code.

Enter whole numbers only- do not enter fractions or decimals.
24G. Days or UnitsGeneral InstructionsA unit represents the number of times the described procedure or service was rendered.

Except as instructed in this manual or in Health First Colorado bulletins, the billed unit must correspond to procedure code descriptions. The following examples show the relationship between the procedure description and the entry of units.

Home and Community-Based Services
Combine units of services for a single procedure code for the billed time period on one detail line. Dates of service do not have to be reported separately. Example: If forty units of personal care services were provided on various days throughout the month of January, bill the personal care procedure code with a From Date of 01/03/XX and a To Date of 01/31/XX and 40 units.
24H. EPSDT/Family PlanNot Required 
24I. ID QualifierNot Required 
24J. Rendering Provider ID #RequiredIn the shaded portion of the field, enter the NPI of the Health First Colorado provider number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic.
25. Federal Tax ID NumberNot Required 
26. Patient's Account NumberOptionalEnter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA).
27. Accept Assignment?RequiredThe accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program.
28. Total ChargeRequiredEnter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number.
29. Amount PaidNot Required 
30. Rsvd for NUCC Use  
31. Signature of Physician or Supplier Including Degrees or CredentialsRequiredEach claim must bear the signature of the enrolled provider or the signature of a registered authorized agent.

Each claim must have the date the enrolled provider or registered authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016.
32. 32- Service Facility Location Information
32a- NPI Number
32b- Other ID #
ConditionalEnter the name, address and ZIP code of the individual or business where the member was seen or service was performed in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.
33. Billing Provider
Info & Ph #
RequiredEnter the name of the individual or organization that will receive payment for the billed services in the following format:
1st Line Name
2nd Line Address
3rd Line City, State and ZIP Code
33a- NPI NumberRequired 
33b- Other ID # If the Provider Type is not able to obtain an NPI, enter the eight-digit Health First Colorado provider number of the individual or organization.

 

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CMS 1500 CHRP Claim Example

CMS 1500 CHRP Claim Example

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Timely Filing

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for more information on timely filing policy, including the resubmission rules for denied claims.

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HCBS CHRP Manual Revisions Log

Revision DateAddition/ChangesMade by
12/1/2016Manual revised for interChange implementation. For manual revisions prior to 12/01/2016, please refer to Archive.HPE (now DXC)
12/27/2016Updates are based on Colorado iC Stage II Provider Billing Manuals Comment Log v0_2.xlsxHPE (now DXC)
1/10/2017Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_3.xlsxHPE (now DXC)
1/19/2017Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_4.xlsxHPE (now DXC)
1/26/2017Updates based on Department 1/20/2017 approval emailHPE (now DXC)
5/22/2017Updates based on Fiscal Agent name change from HPE to DXCDXC
6/26/2018Updated billing and timelyHCPF
6/28/2018Removed HCPCS (duplicated from general)HCPF
12/21/2018Clarification to signature requirementsHCPF
3/19/2019Clarification to signature requirementsHCPF
7/15/2019Updated new services, removed Special Program Code references, clarified CCB responsibility, removed outdated services.HCPF
3/3/2020Converted to web pageHCPF
9/14/2020Added Line to Box 32 under the Paper Claim Reference TableHCPF
10/2/2020Updated language describing CHRP services and eligibility, Changed Supported Community Connections to Community Connector, corrected errors in the Respite modifiers, Place of Service instructions.HCPF
11/18/2020Added in the new RCCF benefit effective 01/01/21HCPF
11/4/2022Added specialtiesHCPF
4/3/2023Updated AWS URL LinksHCPF
6/26/2023Added Specialty Numbers, adjusted where “Intensive Support Services” is listed in the manual.HCPF
7/1/2023Added Level 7 Foster Home/Group Home, adjusted the position of certain services within the billing manual.HCPF
12/20/2023Added Community Connector Parental ProvisionHCPF
2/12/2024Added Respite Additional Services and updated Wraparound ServicesHCPF
4/25/2024Added new Denver County codes and completed correctionsHCPF
5/9/2024Corrected H1 to HA on Wraparound ServicesHCPF
7/19/2024Added duplicative claims language to Claims submission, removed Hippotherapy codes and added link to PT/OT billing manualHCPF