Home and Community Based Services for Persons with Intellectual and/or Developmental Disabilities Waiver Programs

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Program Overview

The Home and Community Based Services (HCBS) waiver programs provide Health First Colorado members who meet special eligibility criteria access to additional services in their homes and communities as an alternative to institutional care. The Home and Community Based Services programs for persons with intellectual and/or developmental disabilities include:

  • Home and Community Based Services for Persons with Intellectual and/or Developmental Disabilities Waiver (HCBS-DD)
  • HCBS-Supported Living Services (HCBS-SLS)
  • HCBS-Children's Extensive Support (HCBS- CES)

Level of care determinations are made annually by the case management agencies (aka Community Centered Boards). Members must meet financial and medical eligibility, as well as program-specific criteria to access services under a waiver. The applicant must be at risk of transition to a nursing facility, hospital, or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). 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 (Colorado's Medicaid Program) covered services except nursing facility, ICF/IID, and long-term hospital care. When a member chooses to receive services under a waiver, the services must be provided by certified Health First Colorado providers.

Each waiver has an enrollment limit. Applicants may apply for more than one waiver but may only receive services through one waiver at a time.

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Persons with Intellectual and/or Developmental Disabilities Waiver (HCBS-DD)

The HCBS-DD Waiver provides persons with intellectual and/or developmental disabilities access to services and supports 24 hours a day to allow them to a live safely and participate in their community. Services include:

  • Residential Habilitation
  • Day Habilitation Services and Supports
    • Specialized Habilitation
    • Supported Community Connections
  • Prevocational Services
  • Supported Employment Services
  • Non-Medical Transportation Services
  • Behavioral Services (for individuals 21 years of age and older)
  • Specialized Medical Equipment and Supplies
  • Dental Services (for individuals 21 years of age and older)
  • Vision Services (for individuals 21 years of age and older)

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Supported Living Services (SLS)

The HCBS-SLS Waiver provides services and supports to assist persons with intellectual and/or developmental disabilities to live in the person's own home, apartment, family home, or rental unit that qualifies as an SLS setting. Services include:

  • Personal Care
  • Respite
  • Homemaker
    • Basic
    • Enhanced
  • Mentorship
  • Day Habilitation Services
    • Specialized Habilitation
    • Supported Community Connections
    • Prevocational Services
  • Supported Employment Services
  • Non-Medical Transportation
  • Behavioral Services (for individuals 21 years of age and older)
  • Professional Services
    • Hippotherapy
    • Movement Therapy
    • Massage Therapy
  • Personal Emergency Response System (PERS)
  • Home Accessibility Adaptations
  • Vehicle Modifications
  • Assistive Technology
  • Dental Services (for individuals 21 years of age and older)
  • Vision Services (for individuals 21 years of age and older)
  • Specialized Medical Equipment and Supplies
  • Home Delivered Meals
  • Life Skills Training
  • Peer Mentorship
  • Transition Setup

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Children's Extensive Support (CES)

The HCBS-CES Waiver is for children ages birth to 18 with intellectual and/or developmental disabilities or for children ages four (4) and under who are at risk of a developmental delay. Services include:

  • Respite
  • Youth Day Services
  • Homemaker
    • Basic
    • Enhanced
  • Community Connector
  • Professional Services
    • Hippotherapy
    • Movement Therapy
    • Massage Therapy
  • Specialized Medical Equipment and Supplies
  • Adapted Therapeutic Recreational Equipment and Fees
  • Home Accessibility Adaptations
  • Vehicle Modifications
  • Assistive Technology
  • Parent Education

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Targeted Case Management (TCM)

Targeted Case Management is an optional Health First Colorado benefit for members who have been determined by a Community-Centered Board (CCB) to have a developmental disability and are actively enrolled in one of the programs listed below.

  • Persons with Intellectual and/or Developmental Disabilities (HCBS-DD) Waiver
  • Supported Living Services (HCBS-SLS) Waiver
  • Children's Extensive Support (HCBS-CES) Waiver
  • Children's Residential Habilitation Program (HCBS-CHRP) Waiver

TCM - Per Member/per Month (PM/PM) services

A component of TCM is paid on a PM/PM basis and requires that the Community Centered Board document provision of a billable activity in the Benefits Utilization System no less frequently than monthly in order to be eligible for reimbursement. Billable activities include, but are not limited to, the following:

  • Comprehensive assessment and periodic reassessment of individual needs,
  • Development and periodic revision of a specific care plan,
  • Referral and related activities to help a Client obtain needed services

 

  • Monitoring and follow-up includes activities that are necessary to ensure the care plan is implemented and adequately addresses the member's needs.

TCM - Monitoring Visits

A separate component of TCM encompasses face-to-face monitoring the quality of services to ensure the member is receiving services in accordance with the service plan. Rural travel add-ons may only be billed with one of the required, quarterly face-to-face visits. Rural travel add-ons may be billed for members residing in counties designated as rural or frontier. This work includes monitoring the effective and efficient provision of services across multiple funding sources.

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Prior Authorization Requests (PARs)

Unless otherwise noted, all HCBS services require prior approval before they can be reimbursed by Health First Colorado. Case management agencies/CCBs complete the Prior Approval and/or Cost Containment requests for their specific programs according to instructions published in the regulations for the Department of Health Care Policy and Financing (the Department). The telephone numbers for the aforementioned Departments are listed in Appendix A, under the Appendices drop-down section on the Billing Manuals web page.

The case management agencies/single entry points transmit electronic PAR information to the Medicaid Management Information System (interChange) for the HCBS-DD Waiver, HCBS-SLS Waiver, HCBS-CES Waiver, and the HCBS-CHRP Waiver through the Bridge subsystem of the interChange.

The CMAs/CCBs 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 Approval and/or Cost Containment Record Form of services and projected costs for approval.
  • Submitting a copy of the Prior Authorization and/or Cost Containment document to the authorizing agent. A list of authorizing agents can be found by referring to Appendix D, under the Appendices drop-down section on the Billing Manuals web page.
  • 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 Health First Colorado payment and does not serve as a timely filing waiver. Prior authorization only assures that the approved service is determined to be necessary and is considered a benefit of the 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 at any time during the individual's plan year.

The authorizing agent or case management agency/CCB is responsible for timely submission and distribution of copies of approvals to agencies and providers contracted to provide services.

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PAR Submission

All PAR forms are filed via the Bridge, which directly interfaces with the Colorado interChange Medicaid Management Information System. Access to the Bridge is afforded to case managers only and is accomplished via the Medicaid Enterprise User Provisioning System (MEUPS).

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Claim Submission

Refer to the General Provider Information manual for general billing information, including claims submission.

HCBS-DD Procedure Code Table

Providers may bill the following procedure codes for HCBS-DD services:

Persons with Intellectual and/or Developmental Disabilities (HCBS-DD)
Description Procedure Code Modifier(s) Level Unit Designation
Residential Habilitation
Group Residential Services and Supports (GRSS) T2016
T2016
T2016
T2016
T2016
T2016
T2016
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
U3, SC, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Day
Day
Day
Day
Day
Day
Day
Individual Residential Services and Supports (IRSS) T2016
T2016
T2016
T2016
T2016
T2016
T2016
U3
U3, 22
U3, TF
U3, TF, 22
U3, TG
U3, TG, 22
U3, SC
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Day
Day
Day
Day
Day
Day
Day
Individual Residential Services and Supports/Host Home (IRSS/HH) T2016
T2016
T2016
T2016
T2016
T2016
T2016
U3, TT
U3, 22, TT
U3, TF, TT
U3, TF, 22, TT
U3, TG, TT
U3, TG, 22, TT
U3, SC, TT
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Day
Day
Day
Day
Day
Day
Day
Day Habilitation Services
Specialized Habilitation - Tier 2 (Traditional/Current) T2021
T2021
T2021
T2021
T2021
T2021
T2021
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
U3, SC, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Specialized Habilitation - Tier 3 (Individual) S5100 U3 All Levels 15 Minutes
Supported Community Connections - Tier 2 (Traditional/Current) T2021
T2021
T2021
T2021
T2021
T2021
T2021
U3
U3, 22
U3, TF
U3, TF, 22
U3, TG
U3, TG, 22
U3, SC
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Supported Community Connections - Tier 3 (Individual) S5100 U3, HB All Levels 15 Minutes
Supported Employment
*Job Development and Job Placement are available as waiver services only when those services are first denied by the Division of Vocational Rehabilitation (DVR) or those DVR services are not available to the member due to an order of selection (DVR waiting list).
Job Coaching
(Group)
T2019
T2019
T2019
T2019
T2019
T2019
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Job Coaching
(Individual)
T2019 U3, SC All Levels 15 Minutes
Job Development
(Group)
H2023 U3, HQ    
Job Development
(Individual)
H2023
H2023
H2023
U3
U3, 22
U3, TF
Level 1-2
Level 3-4
Level 5-6
15 Minutes
15 Minutes
15 Minutes
Job Placement
(Group)
H2024 U3, HQ All Levels Dollar
Job Placement
(Individual)
H2024 U3 All Levels Dollar
Pre-Vocational Services T2015
T2015
T2015
T2015
T2015
T2015
U3, HQ
U3, 22, HQ
U3, TF, HQ
U3, TF, 22, HQ
U3, TG, HQ
U3, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Non-Medical Transportation (NMT)
Other (Public Conveyance) T2004 U3 Single Dollar
Mileage Range 1
Mileage Range 2
Mileage Range 3
T2003
T2003
T2003
U3
U3, 22
U3, TF
0-10 miles
11-20miles
20 miles
Trip
Trip
Trip
Behavioral Services
*Behavioral Services for individuals aged 18-20 on the DD waiver must be accessed through state plan benefits or EPSDT.
Behavioral Line Staff H2019 U3 Single 15 Minutes
Behavioral Consultation H2019 U3, 22, TG All Levels 15 Minutes
Behavioral Counseling (Individual) H2019 U3, TF, TG All Levels 15 Minutes
Behavioral Counseling (Group) H2019 U3, TF, HQ All Levels 15 Minutes
Behavioral Plan Assessment T2024 U3, 22 All Levels 15 Minutes
Specialized Medical Equipment and Supplies
Disposable Supplies T2028 U3 All Levels Dollar
Equipment T2029 U3 All Levels Dollar
Dental Services
*Dental Services for individuals aged 18-20 on the DD waiver must be accessed through state plan benefits or EPSDT.
Basic/Preventative D2999 U3 All Levels Dollar
Major D2999 U3, 22 All Levels Dollar
Vision
*Vision services for individuals aged 18-20 on the DD waiver must
be accessed through state plan benefits or EPSDT.
V2799 U3 All Levels Dollar
Home Delivered Meals S5170 U3   1 unit = 1 meal
Peer Mentorship H2015 U3   1 unit = 15 minutes

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HCBS-SLS Procedure Code Table

Supported Living Services (SLS)
Description Procedure Code Modifier(s) Level Unit Designation
Personal Care T1019 U8 All Levels 15 Minutes
Respite Care
Individual S5150
S5151
U8
U8
All Levels
All Levels
15 Minutes
Day
Group S5151 U8, HQ All Levels Dollar
Group Overnight (Camp) T2036 U8 All Levels Dollar
Homemaker
Basic
Enhanced

S5130
U8
U8, 22
All Levels
All Levels
15 Minutes
15 Minutes
Mentorship H2021 U8 All Levels
All Levels
15 Minutes
15 Minutes
Day Habilitation
Specialized Habilitation - Tier 2- (Traditional/Current) T2021
T2021
T2021
T2021
T2021
T2021
U8, HQ
U8, 22, HQ
U8, TF, HQ
U8, TF, 22, HQ
U8, TG, HQ
U8, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Specialized Habilitation - Tier 3 (Individual) S5100 U8 All Levels 15 Minutes
Supported Community Connections - Tier 2 (Traditional/Current) T2021
T2021
T2021
T2021
T2021
T2021
U8
U8, 22
U8, TF
U8, TF, 22
U8, TG
U8, TG, 22
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Supported Community Connections - Tier 3 (Individual) S5100 U8, HB All Levels 15 Minutes
Pre-Vocational Services T2015
T2015
T2015
T2015
T2015
T2015
U8, HQ
U8, 22, HQ
U8, TF, HQ
U8, TF, 22, HQ
U8, TG, HQ
U8, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Supported Employment
*Job Development and Job Placement are available as waiver services only when those services are first denied by the Division of Vocational Rehabilitation (DVR) or those DVR services are not available to the member due to an order of selection (DVR waiting list).
Job Coaching (Group) T2019
T2019
T2019
T2019
T2019
T2019
U8, HQ
U8, 22, HQ
U8, TF, HQ
U8, TF, 22, HQ
U8, TG, HQ
U8, TG, 22, HQ
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
15 Minutes
Job Coaching (Individual) T2019 U8, SC All Levels 15 Minutes
SE Job Development- Group H2023 U8, HQ All Levels 15 Min.
SE Job Development- Individual H2023
H2023
H2023
U8
U8, 22
U8, TF
Level 1-2
Level 3-4
Level 5-6
15 Min.
15 Min.
15 Min.
SE Job Placement- Group H2024 U8, HQ All Levels Dollar
SE Job Placement- Individual H2024 U8 All Levels Dollar
Non-Medical Transportation (NMT)
Day Program - Mileage Range 1
Day Program - Mileage Range 2
Day Program - Mileage Range 3
T2003
T2003
T2003
U8
U8, 22
U8, TF
0 to 10
11 to 20
21 and Up
Trip
Trip
Trip
Not Day Program T2003 U8, SC All Distances Trip
Other (Public Conveyance) T2004 U8 All Distances Dollar
Behavioral Services
*Behavioral Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT.
Behavioral Line Staff H2019 U8 All Levels 15 Minutes
Behavioral Consultation H2019 U8, 22, TG All Levels 15 Minutes
Behavioral Counseling (Individual) H2019 U8, TF, TG All Levels 15 Minutes
Behavioral Counseling (Group) H2019 U8, TF, HQ All Levels 15 Minutes
Behavioral Plan Assessment T2024 U8, 22 All Levels 15 Minutes
Professional Services
Massage Therapy 97124 U8 All Levels 15 Minutes
Movement Therapy Bachelors
Movement Therapy Masters
G0176
G0176
U8
U8, 22
All Levels 15 Minutes
15 Minutes
Hippotherapy- Individual
Hippotherapy- Group
S8940
S8940
U8
U8, HQ
All Levels 15 Minutes
15 Minutes
Recreational Facility Fees/Passes S5199 U8 All Levels Dollar
Specialized Medical
Supplies and Disposable T2028 U8 All Levels Dollar
Equipment T2029 U8 All Levels Dollar
Personal Emergency Response System (PERS) S5161 U8 All Levels Dollar
Home Accessibility Adaptations S5165 U8 All Levels 1 unit = half of each modification
Vehicle Modifications T2039 U8 All Levels Dollar
Assistive Technology T2035 U8 All Levels Dollar
Dental
*Dental Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT.
Basic / Preventative D2999 U8 All Levels Dollar
Major D2999 U8, 22 All Levels Dollar
Vision Services *Vision Services for individuals aged 18-20 on the SLS waiver must be accessed through state plan benefits or EPSDT. V2799 U8 All Levels Dollar
Transition Services
Home Delivered Meals S170 U8 All Levels Per Meal
Life Skills Training H2014 U8 All Levels 15 Minutes
Peer Mentorship H2015 UB All Levels 15 Minutes
Transition Setup - Coordination T2038 U8 All Levels 15 Minutes
Transition Setup - Items Purchased A9900 UB All Levels One-time Payment

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CES Procedure Code Table

Providers may bill the following procedure codes for HCBS-CES services:

Children's Extensive Support (CES)
Description Procedure Code Modifier(s) Unit Designation
Respite Care
Individual S5150
S5151
U7
U7
15 Minutes
Day
Group S5151 U7, HQ Dollar
Group Overnight (Camp) T2036 U7 Dollar
Youth Day
Individual T2027 U7 15 minutes
Group T2027 U7, HQ 15 minutes
Homemaker
Basic
Enhanced
S5130
S5130
U7
U7, 22
15 Minutes
15 Minutes
Community Connector H2021 U7 15 Minutes
Professional Services
Massage Therapy 97124 U7 15 Minutes
Movement Therapy Bachelors
Movement Therapy Masters
G0176
G0176
U7
U7, 22
15 Minutes
15 Minutes
Hippotherapy Individual
Hippotherapy Group
S8940
S8940
U7
U7, HQ
15 Minutes
15 Minutes
Specialized Medical Equipment and Supplies
Disposable Supplies
Equipment
T2028
T2029
U7
U7
Dollar
Dollar
Adapted Therapeutic Recreational
Equipment
Recreational Facility Fees/Passes
T1999
S5199
U7
U7
Dollar
Dollar
Home Accessibility Adaptations S5165 U7 1 unit = half of each modification
Vehicle Modifications T2039 U7 Dollar
Assistive Technology T2035 U7 Dollar
Parent Education H1010 U7 Dollar / $1,000 Max. Year

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TCM Procedure Code Table

Providers may bill the following procedure codes for TCM services:

Targeted Case Management (TCM) - CHRP CES, DD, SLS
Description Procedure Code Modifier(s) Unit Designation
Targeted Case Management, per member, per month T2023   1 Unit, maximum of 12 units per service plan year
Targeted Case Management - Monitoring Visit T2024   1 Unit, Maximum of four (4) units per service plan year
Targeted Case Management - Monitoring Visit, rural add-on T2024 TN 1 Unit, Maximum of four (4) units per service plan year

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HCBS- CES, DD, and SLS Paper Claim Reference Table

The following paper form reference table describes required fields for the paper CMS 1500 claim form for HCBS-CES, HCBS- DD, and HCBS- SLS claims:

CMS Field Number & Label Field is? Instructions
1. Insurance Type Required Place an "X" in the box marked as Medicaid.
1a. Insured's ID Number Required Enter the member's Health First Colorado seven-digit Medicaid ID number as it appears on the Medicaid Identification card. Example: A123456.
2. Patient's Name Required Enter the member's last name, first name, and middle initial.
3. Patient's Date of Birth/Sex Required Enter 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 Name Not required  
5. Patient's Address Not Required  
6. Client Relationship to Insured Not Required  
7. Insured's Address Not Required  
8. Reserved for NUCC Use Not Required  
9. Other Insured's Name Not Required  
9a. Other Insured's Policy or Group Number Not Required  
9b. Reserved for NUCC Use    
9c. Reserved for NUCC Use    
9d. Insurance Plan or Program Name Not Required  
10a-c. Is patient's condition related to? Not Required  
10d. Reserved for Local Use    
11. Insured's Policy, Group or FECA Number Not Required  
11a. Insured's Date of Birth, Sex Not Required  
11b. Other Claim ID Not Required  
11c. Insurance Plan Name or Program Name Not Required  
11d. Is there another Health Benefit Plan? Not Required  
12. Patient's or Authorized Person's signature Required Enter "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 Signature Not Required  
14. Date of Current Illness Injury or Pregnancy Not Required  
15. Other Date Not Required  
16. Date Patient Unable to Work in Current Occupation Not Required  
17. Name of Referring Physician Conditional  
18. Hospitalization Dates Related to Current Service Not Required  
19. Additional Claim Information Conditional  
20. Outside Lab?
$ Charges
Not Required  
21. Diagnosis or Nature of Illness or Injury Required Enter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition.

Enter applicable ICD-10 indicator.

HCBS
DD, CES and SLS may use R69
22. Medicaid Resubmission Code Conditional List 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 Authorization Not Required HCBS
Leave blank
24. Claim Line Detail Information The 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 Service Required 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.
From To
01 01 19      
or
From To
01 01 19 01 01 19
Span dates of service
From To
01 01 19 01 31 19
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 Service Required

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.

11 Office
12 Home
24C. EMG Not Required  
24D. Procedures, Services, or Supplies Required Enter the procedure code that specifically describes the service for which payment is requested.

HCBS
Refer to the HCBS-DDHCBS-CESHCBS-SLS or TCM procedure code tables.
24D. Modifier Required 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.
Refer to the HCBS-DD, HCBS-CES or HCBS-SLS or TCM procedure code tables.
24E. Diagnosis Pointer Required Enter 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. $ Charges Required Enter 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 Units Required Enter the number of services provided for each procedure code.

Enter whole numbers only- do not enter fractions or decimals.
24G. Days or Units General Instructions A 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 & 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 Plan Not Required  
24I. ID Qualifier Not Required  
24J. Rendering Provider ID # Required In 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 Number Not Required  
26. Patient's Account Number Optional Enter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA).
27. Accept Assignment? Required The accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program.
28. Total Charge Required Enter 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 Paid Not Required  
30. Rsvd for NUCC Use    
31. Signature of Physician or Supplier Including Degrees or Credentials Required Each 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 #
Conditional Enter 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 #
Required Enter 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 Number Required  
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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Timely Filing

For more information on timely filing policy, including the resubmission rules for denied claims, please see the General Provider Information manual available on the Billing Manuals web page under the General Provider Information drop-down menu.

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Home and Community Based Services (HCBS) Intellectual and/or Developmental Disabilities (IDD) Manual Revisions Log

Revision Date Addition/Changes Made by
12/1/2016 Manual revised for interChange implementation. For manual revisions prior to 12/01/2016, please refer to Archive. HPE (now DXC)
12/27/2016 Updates based on Colorado iC Stage II Provider Billing Manual Comment Log v0_2.xlsx HPE (now DXC)
1/10/2017 Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_3.xlsx HPE (now DXC)
1/19/2017 Updates based on Colorado iC Stage Provider Billing Manual Comment Log v0_4.xlsx HPE (now DXC)
1/26/2017 Updates based on Department 1/20/2017 approval email HPE (now DXC)
5/22/2017 Updates based on Fiscal Agent name change from HPE to DXC DXC
12/13/2017 Updates for addition of the modifier codes under the SLS Behavioral Plan assessment provided by Department DXC
6/26/2018 Updated timely filing HCPF
6/28/2018 Updated claims submissions HCPF
7/31/2018 Updated program benefits to reflect benefits no longer under waiver services but in state plan, removed benefits (behavioral, vision, dental and personal care) from appropriate tables and program lists for CES, SLS, DD HCPF
12/21/2018 Clarification to signature requirements HCPF
3/19/2019 Clarification to signature requirements HCPF
7/2/2019 Updated Appendices' links and verbiage DXC
12/4/2019 Updated CES and SLS service units HCPF
12/27/2019 Removed references to CCMS/DDDWeb, Special Program Code. Added CHRP as waiver for which TCM is billed, added requirement for U4 Modifier for TCM related to SCR 44697. HCPF
3/3/2020 Converted to web page HCPF
3/4/2020 Updated SLS to include (4) transition services to SLS and Youth Day to CES HCPF
6/4/2020 Updated coding and language description for TCM, removed references to Special Program Code, minor edits. HCPF
7/27/2020 Added POS 11 to 24B HCPF
9/14/2020 Added Line to Box 32 under the Paper Claim Reference Table HCPF
12/1/2020 Added Tier 3 SCC and SpecHab procedure/modifier combinations to the DD and SLS waivers. HCPF