Colorado is reforming its behavioral health system. This transformation is vital to make sure every Coloradan can access the behavioral health care they need when they need it. The Department of Health Care Policy and Financing is working to expand the spectrum of behavioral health services for Health First Colorado (Colorado’s Medicaid program) members. This includes increasing access to peer services for members. These services are supportive and skill-building activities delivered by peer support professionals.
Peer support professionals are individuals who use their lived experience to help others. Peers can work in a variety of settings and offer support in any area where a member with a diagnosis is receiving care from a Health First Colorado provider. Peers are an addition to the member’s care team. They can offer practical solutions and focused problem solving to help members practice building skills needed to maintain their health and wellbeing.
Frequently Asked Questions:
- Do I need a license to work as a Peer?
No. Individual peers do not need a license to work as a peer. Peers may seek credentialing and become certified peers. To work in a Recovery Support Service Organization (RSSO), which is a licensed provider organization, peers must be certified.
- Are Peer services billable?
Many, but not all, peer services are billable. For a peer service to be billable, the member receiving the service must have a covered diagnosis. Then, in accordance with the State Behavioral Health Services Billing Manual (the billing manual), any billable code that indicates a Peer as a service provider may be eligible for reimbursement.
- How do covered Peer services get billed?
Bills for peers services are submitted under the name of the licensed person, who oversees clinical care services for the member and is referred to as the “rendering provider”.
- Who do I contact for help with billing and coding questions?
Please reach out to your Managed Care Entity (MCE- RAE or MSO) or you can contact the Department for questions about the billing manual at email@example.com
Recovery Support Services Organizations New to Health First Colorado
Reasons to become a Health First Colorado-enrolled provider:
- Individuals being served are Health First Colorado members
- Health First Colorado members have low to no co-pays, and no deductible, which means providers are paid for their full service amount immediately from the health plan.
- Health First Colorado’s behavioral health payments are often faster than commercial payers, with 98% of claims paid within 10 days of billing.
To become a Health First Colorado Recovery Support Services Organization (RSSO provider type 89) follow these 3 steps:
- Step 1: First, a provider (organization) must apply to become licensed through the BHA to provide recovery support peer services for SUD, mental health and trauma. The following page provides detailed information about the SUD licensure requirements and process.
- Step 2: Next, a provider identifies their Health First Colorado provider type - and enrolls with Medicaid.
- Step 3: Once enrolled as a Health First Colorado, a provider must contract with Managed Care Entities to serve members from one or more regions.