Provider FAQ Central

Billing

Accounting

Accounting Fact Sheet (includes EDI, EFT, and Paper Warrant information)

Appeals

If all means of achieving satisfactory claim resolution through the fiscal agent and the Claims Processing unit have been exhausted, providers may file a written appeal with the Office of Administrative Courts, at the address listed in Appendix A on the Billing Manuals web page under Appendices.

Appeals submitted to the Office of Administrative Courts must be received within 30 days from the mailing date of the last notice of action.

Eligibility

Eligibility Fact Sheet

Load Letters

Load Letter Fact Sheet

Change of Ownership (CHOW) FAQs

The following are specific resources to assist in better understanding questions around when a change of ownership has occurred and what steps providers need to take to prepare.

What is a change of ownership?

A change of ownership occurs when a new tax identification number is issued

 

If there is no change in the tax identification number, a change of ownership notification is not necessary. Other changes, such as a change to the organization's legal name or a change in owners or board of directors can be handled with a simple update to the provider's existing information.

If my organization's board of directors turns over and a new board is appointed, does that constitute a change of ownership?

No. Appointing a new board of directors does not constitute a change of ownership.

How do I prepare for the change of ownership?

Before the new owner starts billing, an application must be submitted for the new business. The seller must stop billing claims before the new owner begins billing.

What needs to be done if there is a Change of Ownership?

Providers with a change in tax ID number must re-apply, complete a new Medical Assistance Program Provider Participation Agreement, and be fully approved in order to participate in Health First Colorado. The previous Health First Colorado number must be disenrolled and a new Health First Colorado number will be assigned.

Can the same National Provider Identifier (NPI) be used after the ownership has changed?
Providers are strongly encouraged to apply for a new NPI whenever a new tax identification number is issued. If the decision is made to transfer the existing NPI to the new owner, the previous owner is advised to submit all claims before the transfer is made. A separate taxonomy will be required for the new owner if the NPI will be shared.
Can a provider change their Tax ID on their enrollment record?
No. Providers must apply for a new Health First Colorado ID with the new Tax ID.

Fingerprinting

Fingerprint Criminal Background Check (FCBC)

Pharmacy Info and FAQs

Pharmacy Info and FAQs

Timely Filing FAQs

These frequently asked questions focus on common issues providers ask when trying to better understand the rules and exemptions for timely filing. Additional information on timely filing is also available in the General Provider Information manual located on the Billing Manual web page.