Keep contact information current. Communications will go to the contact email address in the application. If the contact information changes but is not updated in the system, important communications will not be received.
Save username and password for enrollment applications. If the password and security questions are forgotten, a new application must be started. It cannot be reset.
Attachments
Submit each document separately and label each one. Reviewers may overlook multiple documents submitted together.
Do not submit more information than is required. Adding documentation that is not required for the selected provider type could result in the application being returned. Visit the Enrollment Types web page for enrollment checklists for all enrollment types.
Data in the data fields must match the supporting documentation. Common reasons for applications to be returned are:
Missing licenses (dates or license number)
Incorrect W-9 tax classification
Incorrect banking or Electronic Funds Transfer (EFT) information
Outdated insurance policies (applicable to Nursing Facilities and Home and Community-Based Services [HCBS] providers only)
Verify data is being entered in the correct field. Submitting Department of Regulatory Agencies (DORA) license data in the Board Certifications panel will cause an application to be returned for corrections. If two (2) licenses are attached, add the data for both licenses in the data panel. The data must match between what is entered in the application and the copy attached to the application.
Read the instructions regarding assessments questions (i.e., ownership and control interest). The questions relate to who or what has an ownership/control interest in the provider that is applying. If the applicant is an Individual Within a Group or a Billing Individual, it is unlikely that someone has an ownership interest in that person. Ownership interest for groups must be completed according to the Assessments quick sheet. Interest can be entered as 0% for Board of Directors or must be entered for 5% or greater ownership/control interest (if companies or individuals own the provider). Ownership information should match with that enrollment if a group is enrolled with Medicare.
Enrollment Types
Visit the Find Your Provider Type web page for help when selecting the correct provider type. The enrollment type or provider type cannot be changed once an application has been started. A new application must be started if the wrong type has been selected.
Select Clinic (Provider Type 16) if there is an affiliated Doctor of Medicine (MD)/Doctor of Osteopathic Medicine (DO), Doctor of Podiatric Medicine (DPM) or Doctor of Optometry (OD) in a group.
Select Non-Physician Practitioner Group (Provider Type 25) if a group is led by an Advanced Practice Nurse (APN), an audiologist, a psychologist (LMFT, LCSW, LPC, PhD, PsyD), or a Physical Therapist.
Case Managers (Provider Type 11) must have a contract with the Department of Health Care Policy & Financing (the Department) as a Community Centered Board (CCB) or Single-Entry Point agency (SEP). Visit the Case Management Agency Directory web page for more information.
HCBS Waiver Service Providers (Provider Type 36) should only enroll for approved specialties. Submitting non-qualified specialties will delay the application.
Behavioral Health
Do not select Community Mental Health Center (CMHC) unless licensed as such with the Department of Public Health & Environment (CDPHE) and belong to the Colorado Behavioral Health Council.
Do not select Regional Accountable Entity (RAE) if not a Health Maintenance Organization (HMO) or Limited-Service Licensed Provider Network (LSLPN) and contracted with the Department to manage a specific geographic region of Colorado.
Substance Use Disorder (SUD) services providers must be licensed as an SUD Clinic (Provider Type 64) or Licensed Behavioral Health Clinician (LBHC) (Provider Type 38) and must meet dual licensing requirements noted on the Department’s website. For SUD clinics, the dually licensed supervising practitioner must also be enrolled in Health First Colorado (Colorado's Medicaid program).
Individuals
Enroll only once. Multiple enrollments can result in claim denials. Notify all groups of the enrollment. Contact the Provider Services Call Center to verify individual enrollment status before submitting an application.
Update the practitioner license and National Provider Identifier (NPI) when moving to Colorado from another state.
Use a Social Security Number (SSN) as the tax ID. Do not submit the federal tax ID (FEIN) of the billing group.
DORA license: Submit the license number, effective date, end date and the licensing state. Be sure to enter the entire license number including alpha and numerical characters as well as dots, dashes, etc. Verify the license is current. Attach both the current and new licenses by adding both to the data panel if the license will expire within two (2) weeks of an application submission.
