Provider News

Members who require non-emergent transportation to and from medical appointments in the Denver area can call Transdev Health Solutions at (303) 398-2155 or (720) 279-3830 to schedule a ride. Members outside the Denver area can contact a provider from the Non-Emergent Medical Transportation (NEMT) Service Area list.

Claims billed with a HCPCS 2025 procedure code were suspending for EOB 0000 - "This claim/service is pending for program review," beginning January 1, 2025. The Colorado interChange has been updated with the 2025 HCPCS billing codes based on the Centers for Medicare & Medicaid Services (CMS) annual release of deletions, changes and additions.

Claims completed reprocessing on 3/7/2025.

Providers are reminded to check the Provider Rates and Fee Schedule web page before billing to ensure the codes are a covered benefit. All codes must be reviewed for medical necessity, prior authorization coverage standards and rates before the codes are reimbursable.

Providers are reminded that management of the Provider Services Call Center will transition from Gainwell Technologies (Gainwell) to OptumInsight (Optum).

What providers should know:

• On May 1, 2025, Optum will officially take over management of the Provider Services Call Center.
• The Provider Services Call Center phone number will change. The Department will announce the new phone number closer to the transition.
• Optum is only taking over management of the Provider Services Call Center. Gainwell will continue as the vendor for the Colorado interChange and the Provider Web Portal.
• This vendor change will only apply to the Provider Services Call Center. The Care and Case Management (CCM), Dental, Pharmacy and Electronic Visit Verification (EVV) call centers will not change. For a complete list of assistance resources, visit the Provider Contacts web page. This vendor transition will add enhancements to the Provider Services Call Center. Some of the changes include:
  • Providers being offered an after-call survey to provide valuable feedback about their call
  • Providers being able to use their National Provider ID or their Health First Colorado Provider ID

Visit the Colorado Medicaid Enterprise Solutions (CMES) Transition web page for more information.

Provider News & Resources - 03-17-2025 Issue 111 - This newsletter contains Did You Know? Members Requiring Non-Emergent Medical Transportation (NEMT) Services; Reconsiderations and Appeals; Stakeholder Meeting: County Administration Rules; Provider Call Center Transition; Vision Providers: Ordering, Prescribing and Referring (OPR) Claim Identifier Mandate; Revalidation Reminder: Name Matching; Recently Updated Billing Manuals and Fee Schedules; Known Issue: Lactation Support Services Providers: Claims billed with the Lactation Support Services procedure code S9443 are denying for Explanation of Benefits (EOB) 2022 – “A National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) that sets when the units of service are billed in excess of established standards for services that a member would receive on a single date of service for a given CPCS/CPT code;” Resolved Known Issue: Pharmacy Providers: Resolved 3/14/2025: Some Professional Claims Billed by Pharmacy Providers were Denying for Explanation of Benefits (EOB) 1381 – "No Billing Rule for Procedure;" Resolved Known Issue: Clinic – Practitioner Providers: Resolved 3/10/25: Some Professional Claims Billed with Procedure Code G0416 for Clinic Surgery Services were Paying Incorrectly when Billed with Modifier 26; Resolved Known Issue: Home and Community-Based Services (HCBS) Providers: Resolved 2/27/25: In-Home Support Service (IHSS) Claims were Denying for Explanation of Benefits (EOB) 3054 – “EVV Record Required and Not Found”

Provider News & Resources - 02-21-2025 Issue 110 - This newsletter contains Did You Know? Third Party Liability (TPL); Members Requiring Non-Emergent Medical Transportation (NEMT) Services; Provider Web Portal Extended Maintenance Starts Friday, February, 21, 2025 at 6:00 PM MT; Reminder: Signatures on Paper Claims; Reminder: Mailing Address for Paper Claims; Stakeholder Meeting: County Administration Rules; Home and Community-Based Services (HCBS): Working Adults with Disabilities Stakeholder Meeting Announcement and Invitation; Bariatric Surgery Rule Revision – Upcoming Stakeholder Meeting on March 13, 2025; Recently Updated Billing Manuals and Fee Schedules; Home and Community-Based Services (HCBS) Providers - Known Issue: In Home Support Service (IHSS) Claims Are Denying for Explanation of Benefits (EOB) 3054 – “EVV Record Required and Not Found.” 

Provider News & Resources - 02-14-2025 Issue 109 - This newsletter contains information on Did You Know? Missed Revalidation Date; Healthcare Common Procedural Coding System (HCPCS) Codes for 2025; Members Requiring Non-Emergent Transportation (NEMT) Services; Load Letters; Important Update Regarding Handling Exception Acknowledgments for Providers Using Provider Choice Systems For Electronic Visit Verification (EVV); Stakeholder Meeting: County Administration Rules; Home and Community-Based Services (HCBS): Working Adults with Disabilities Stakeholder Meeting Announcement and Invitation; Bariatric Surgery Rule Revision – Upcoming Stakeholder Meeting on March 13, 2025; Recently Updated Billing Manuals and Fee Schedules; All Provider Types: Resolved Known Issue: Some Sandata Provider Electronic Visit Verification (EVV) Portals may not have been be functioning as expected, and claims may have been impacted; Home & Community-Based Services (HCBS): Resolved Known Issue: Some HCBS Services Claims Were Denied Incorrectly; Featured Resources: February 2025 Provider Bulletin (B2500519), Special Newsletter - Revalidation, Special Bulletin – Non-Emergent Medical Transportation (NEMT) (B2400515); Upcoming Holidays: President's Day - Monday, February 17, 2025.

Provider News & Resources - Revalidation Special Newsletter - 01-27-2025 - This newsletter contains information on Federal Mandate for Revalidation; Did You Know?; Provider Notifications; Other Change Applications During Revalidation; Recently Asked Questions & Answers

Provider News & Resources - 01-13-2025 Issue 108 - This newsletter contains information on Did You Know? Revalidation Update; Claims for Healthcare Common Procedure Coding System (HCPCS) 2025 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000, 2025 Medicare Part A and Part B Deductible Amounts; Intermediate Billing Training; Non-Emergent Medical Transportation (NEMT) Recorded Training; Non-Emergent Medical Transportation (NEMT) Providers Meeting; Provider Services Call Center Transition Coming This Spring; Enrollment Reminder for Community Mental Health Center Providers; Recently Updated Billing Manuals and Fee Schedules; Physician Services/Clinics: Resolved Known Issue: Incorrect Rate on Fee Schedule for Procedure Code 20680; DME Supply Providers: Resolved Known Issue: Inaccurate Rates in Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Manual; Home and Community-Based Services Providers: Resolved Known Issue: Denied HCBS Services Claims Were Reprocessed on 12/31/24; Featured Resources: Internal Control Number (ICN) Information Sheet and Fingerprinting Enrollment Frequently Asked Questions (FAQ); Upcoming Holiday: Martin Luther King Jr. Day.

Provider News & Resources - 12-16-2024 Issue 107 - This newsletter contains information on Did You Know? Revalidation Spreadsheet; Enrollment Processing Timelines; Claims Denials Begin January 1, 2025 for Past-Due Revalidations; Reminder: Update Address for IRS Form 1099 in Provider Web Portal; Intermediate Billing Training; Non-Emergent Medical Transportation (NEMT) Providers Meeting; Revalidation Explanation of Benefits (EOB) and Requirements for Billing, Individual and OPR Providers; Feasibility Study - Coverage of Housing & Nutrition Services; Provider Enrollment Application Fee Amount for Calendar Year 2025; All Patient Refined–Diagnosis Related Group (APR-DRG) Version 40 Update; Health First Colorado and Child Health Plan Plus (CHP+) Will Expand to Cover Children and Pregnant People Regardless of Immigration Status; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Inaccurate Portal Display for Speech Therapy Units; Inaccurate Rates in Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Manual

Provider News & Resources - 11-25-2024 Issue 106 - This newsletter contains information on Did You Know? Verifying Member Eligibility; Upcoming Webinar: Medicaid Coverage Housing and Nutrition Services Feasibility Study; Vision Providers: Ordering, Prescribing and Referring (OPR) Claim Identifier Mandate; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Physician Services/Clinics: Incorrect Rate on Fee Schedule for Procedure Code 20680; Speech Therapy: Inaccurate Portal Display for Speech Therapy Units; Resolved Known Issues: Ambulatory Care Services, Hospital-General and Physician Services/Clinics: Claims with Certain Procedure Codes Were Paying Incorrect Rates; All Providers: Some Professional Claims and Professional Crossovers Were Paid at an Incorrect Rate

Provider News & Resources - 11-20-2024 Issue 105 - This newsletter contains information on Did You Know? EOB 3110 - Claims Will Not Deny for Individual Not Being Linked to the Group; Upcoming Webinar: Perinatal SUD Community Conversation; Upcoming Webinar: Medicaid Coverage Housing and Nutrition Services Feasibility Study; Potential American Rescue Plan Act (ARPA) HCBS Direct Provider Payment; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Hospice: Rate Update Effective October 11, 2024 (FFY 24-25); Clinic Practitioners, Hospitals - General and Ambulatory Surgery Centers: Claims with Certain Procedure Codes Are Paying Incorrect Rates; Resolved Known Issues: Clinic Practitioners: Claims with Procedure Code 59025 Were Paying Incorrect Rates When Billed with Modifier TC or 26; Clinics and Pediatric Behavioral Therapy: Providers Billing for Pediatric Behavioral Therapy; Featured Resources: Billing Manuals.

Provider News & Resources - 11-04-2024 Issue 104 - This newsletter contains information on Did You Know? Claim Detail Line Limitations; NEMT Providers: Featured NEMT Resources; Clinic Practitioners (PT 16) and SUD Clinics (PT 64): NEMT Information; Doing Business As (DBA) Name Field in the Provider Web Portal; Hospice Providers: Rate Update Effective October 11, 2024 (FFY 24-25); Updated Billing Manuals and Fee Schedules: Appendix R – Remittance Advice (RA) Messages; Pharmacist Services Billing Manual; Health First Colorado Fee Schedule July 2024; Immunization Fee Schedule; Known Issues: Clinic Practitioners (Provider Type 16): Claims with Certain Procedure Codes Are Paying Incorrect Rates; Resolved Known Issues; Featured Resources: November 2024 Provider Bulletin (B2400516); Special Provider Bulletin - Non-Emergent Medical Transportation (NEMT) (B2400515).

Provider News & Resources - 10-21-2024  Issue 103 - This newsletter contains information on Billing for Medicare Advantage Plans; Vision Providers: New EOB Code 5812; National Lead Poisoning Prevention Week: 10/20-10/26; Adult Long-Term Home Health (LTHH); Prescriber Tool Alternative Payment Model (APM) Stakeholder Meetings; Perinatal Substance Use Disorder (SUD) Community Conversation; Updated Billing Manuals and Fee Schedules; Immunization Providers: Resolved Known Issue: Some Claims Denying EOB 1178 or 7800; Clinic Practitioners (PT 16): Resolved Known Issue: Claims for Procedure Code J3301 Denying EOB 7827; Resolved Known Issue: Knee Arthroscopy/Surgery Procedure Code 29877 Paying Incorrect Amount; Behavioral Health Providers: Resolved Known Issue: Some Claims for Behavioral Health Services with Procedure Codes 90791 and 90792 Denying EOB 3981.

Provider News & Resources - 10-14-2024  Issue 102 - This newsletter contains information on Did You Know? Keep Licenses Current; Provider Web Portal Address Panel Changes; NEMT Providers: Revalidation Date Extension; Immunizations; Updated Billing Manuals and Fee Schedules; Known Issue: Short-Term Behavioral Health Service Information and Speech Therapy Units Unavailable in Provider Web Portal; Clinic Practitioners: Known Issue: Claims for Procedure Code J3301 Denying EOB 7827; Known Issue: Knee Arthroscopy/Surgery Procedure Code 29877 Paying Incorrect Amount; Resolved Known Issue: ASC Correction Rate Schedule; Clinic Practitioners: Resolved Known Issue: Some Claims for Procedure Code 83986 Denying EOB 7827.

Provider News & Resources - 09-30-2024  Issue 101 - This newsletter contains information on NEMT Providers: Moratorium on New Enrollments; NEMT Providers: Revalidation Reminder; Updated Billing Manuals and Fee Schedules; Resolved Known Issue: Health First Colorado Fee Schedule; Known Issue: ASC Correction Rate Schedule; Known Issue: Short-Term Behavioral Health Services and Speech Therapy Units Unavailable in Portal.

Provider News & Resources - 09-23-2024  Issue 100 - This newsletter contains information on Provider Enrollment: License Reminder; NEMT Providers: Revalidation Date; Clinic Providers: New SUD Features; All Medication Prescribers: Prescriber Tool APM Stakeholder Meetings; Providers Required to Collect EVV: Proper Use of POS 99; Providers Utilizing EVV: IP Address Change; Reminder: Sign Up for Provider Email Communications; Updated Billing Manuals and Fee Schedules; Resolved Known Issue: Health First Colorado Fee Schedule; Pediatric Behavioral Therapy Providers: Resolved Known Issue: Behavioral Therapy Reimbursements Discrepancy on Fee Schedule.

Provider News & Resources - 09-09-2024  Issue 99 - This newsletter contains information on Did You Know? Backdate Requests; NEMT Providers: Provider Credentialing Program; Pharmacy Providers: Reminder Update Fax Numbers; Updated Billing Manuals and Fee Schedules; Behavioral Health Providers Known Issue: Some Claims Denying EOB 2029; Resolved Known Issue: Health First Colorado Fee Schedule; CHRP Providers Resolved Known Issue: Some Claims with Procedure Code H2021 Denying EOB 3530.

Provider News & Resources - 08-19-2024  Issue 98 - This newsletter contains information on Pediatric Behavioral Therapy; Ordering, Prescribing and Referring Reminder; NEMT Providers: Revalidating Enrollment with Health First Colorado; PT, OT and ST Providers: Audit Limit Details Available During Eligibility Verification; Immunization Providers: COVID-19 Rates; Home and Community-Based Services; Intensive Behavioral Health Services Delivery Model; Date of Death Claim Adjustments; Featured Resource: New Provider Enrollment Training; Updated Billing Manuals and Fee Schedules; Resolved Known Issue: Health First Colorado Fee Schedule.

Provider News & Resources - 08-05-2024  Issue 97 - This newsletter contains information on Did You Know? Verifying Member Eligibility; Inpatient and Outpatient Hospital Providers: July 2024 Rate Updates; All Providers: Paper Claims; Physician Services: Bariatric Surgery Rule Change Consideration Meeting for Providers; NEMT Providers: Revalidating Enrollment with Health First Colorado; Featured Resource: Provider Web Portal Quick Guides; Updated Billing Manuals and Fee Schedules; Known Issue: Health First Colorado Fee Schedule; Resolved Known Issue: Correction Rate Schedule (ASC).

Provider News & Resources - 07-22-2024  Issue 96 - This newsletter contains information on Did You Know? What's New; Featured Quick Guide: Web Portal Registration; All Providers: Navigating the Provider Services Call Center IVR System; All Providers: Revalidation Reminder; Provider Enrollment Training; Correction: Durable Medical Equipment (DME) Manual Pricing; Physician Services: Bariatric Surgery Rule Change Consideration Meeting for Providers; Remote Monitoring for Outpatient Clinical Services Stakeholder Meetings; Updated Billing Manuals and Fee Schedules.

Provider News & Resources - Revalidation Special Newsletter - 06-17-2024 - This newsletter contains information on CMS Federal Mandate; Provider Notifications; Other Change Applications During Revalidation; Recently Asked Questions & Answers; Did You Know? Supplemental Questions Panel; Featured Resources.

Provider News & Resources - 06-10-2024  Issue 95 - This newsletter contains information on Did You Know? Revalidation; Updated Billing Manuals; Verify Member Eligibility; PRTF and QRTP Service Providers: Residential Provider Survey; Reminder: Sign Up for Provider Email Communications; DME Providers: Resolved Known Issue: Professional Claims for DME Wheelchair Repair Services Denying EOB 1997; Hospital Providers: Resolved Known Issue: Institutional Claims with Diagnosis Codes F840, F842, F845 Denying EOB 2029.

Provider News & Resources - 05-24-2024  Issue 94 - This newsletter contains information on License Update Requirement; HCBS Providers: New Denver County and Transportation Codes; HCBS Providers: Member Eligibility Benefit Plan Updates; Updated Billing Manuals; DME Providers: Resolved Known Issue: Professional Claims for DME Wheelchair Repair Services Denying EOB 1997; Hospital Providers: Resolved Known Issue: Institutional Claims with Diagnosis Codes F840, F842, F845 Denying EOB 2029; Audiology and Speech Therapy Providers: Resolved Known Issue: Speech Therapy Claims Denying EOB 0192, 1599 and 4211.

Provider News & Resources - 05-20-2024  Issue 93 - This newsletter contains information on Reminder: Group and Provider Affiliation Updates Required Every Six (6) Months; Did You Know? Revalidation Federal Mandate; System Error for Attachments in the Provider Web Portal; Pediatric Behavioral Therapy Providers: May 2024 Billing Training; Vision Providers: New Coverage of Corneal Crosslinking; Physician Services, Women’s Health: Information Regarding Hepatitis B Infection in Newborns; Featured Resource: Verifying Member Eligibility and Co-Pay; Updated Billing Manuals and Fee Schedules.

Provider News & Resources - 05-03-2024  Issue 92 - This newsletter contains information on Did You Know? Referring National Provider Identifier (NPI); Provider Disenrollment Due to Missing Revalidation; Direct Care Workforce Stabilization Board Public Hearings; Featured Quick Guide: Submitting an Institutional Claim Quick Guide; Updated Billing Manuals; Resolved Known Issue: Speech Therapy Claims Denying EOB 5551.

Provider News & Resources - 04-22-2024  Issue 91 - This newsletter contains information on Did You Know? Provider Disenrollment Due to Missing Revalidation; HCBS Program Aid Code Changes for Member Eligibility; Immunization Providers: Code 90611 Now a Covered Benefit; Reminder: STI Laboratory Testing is a Covered Benefit; LTSS Provider Webinar Announcement; Public Health Order – Syphilis Testing During Pregnancy; HCBS: Direct Care Workforce Stabilization Board Public Hearings; Updated Billing Manuals; Known Issue: Some Speech Therapy Claims for Evaluation Services are Denying for EOB 5551; Resolved Known Issue:  Some BHS Claims with SC Modifier Denying for EOB 2029; Resolved Known Issue: Some PT/OT Claims Denying for EOB 2305; Featured Resource: April 2024 Provider Bulletin (B2400507)

Provider News & Resources - 04-08-2024  Issue 90 - This newsletter contains information on Did You Know? Claim Submissions; PAD Providers: Quarter 2 Rate Update 2024; Updated Billing Manuals; NEMT Enrollments Continue to be Closed; Public Meeting to Gauge Community Interest in Potential Application to Federal Transforming Maternal Health (TMaH) Model; HCBS Program Aid Code Changes for Member Eligibility; LTSS Provider Webinar Announcement; HCBS: Direct Care Workforce Stabilization Board Public Hearings; Featured Resource: Revalidation FAQ; Known Issue: Some PT/OT Claims Denying for EOB 2305; Resolved Known Issue: Some Claims Billed by Optical Outlets Denying EOB 1997; Resolved Known Issue: Some Claims for PAD Denying EOB 7827.

Provider News & Resources - 03-25-2024  Issue 89 - This newsletter contains information on Did You Know? License Update Requirement; Moratorium on New Enrollments for NEMT; OPR: Enrollment Requirement; PAR Process When Health First Colorado is the Secondary Payer; HCBS: Benefit Plan Extension; Featured Resource: Revalidation FAQ; Reminder: Update Fax Numbers; Updated Billing Manuals; Resolved Known Issue: Professional Claims for DME Services Denying EOB 3530; Resolved Known Issue: Professional Claims for DME Services Denying EOB 7827; Resolved Known Issue: Institutional Claims Denying EOB 0192.

Provider News & Resources - 03-11-2024  Issue 88 - This newsletter contains information on Did You Know? Claim Submission Methods; Optum Change Healthcare (CHC) Cyber Security Issue; OPR Providers Required on Claims; Featured Resource: Revalidation FAQ; Updated Billing Manuals; Ambulatory Surgical Center Payment Methodology - Virtual Meetings; Known Issue: Behavioral Health Services Claims with SC Modifier Are Denying Incorrectly for EOB 2029; Resolved Know Issue: Claims for HCPCS 2024 PAD Procedure Codes Suspending EOB 0000.

Provider News & Resources - 03-04-2024  Issue 87 - This newsletter contains information on Did You Know? Enrollment Processing Time; Some Claims for HCPCS 2024 PAD Procedure Codes Suspending EOB 0000; Inpatient Hospital Base Rates Fiscal Year (FY) 23-24 Update; Supplemental Rate Increases; PAD Providers: Record Keeping and Retention; Updated Billing Manuals and Fee Schedules.

Provider News & Resources - Special Newsletter - Durable Medical Equipment (DME) Known Issues - 03-04-2024 - This newsletter contains information on Known Issue: Some Professional Claims with Durable Medical Equipment (DME) E2599, K0108 and T5999 Procedure Codes Denying for Explanation of Benefits (EOB) 7827; Resolved Known Issue: Resolved 02/27/24: Some Professional Claims for Durable Medical Equipment (DME) Services for Procedure Code A4287 Denying for Explanation of Benefits (EOB) 0192; Resolved 02/24/24: Some Professional Claims for Durable Medical Equipment (DME) Services for Procedure Code E0955 with Modifier NU Suspending for Explanation of Benefits (EOB) 2861.

Provider News & Resources - 02-26-2024  Issue 86 - This newsletter contains information on Doula Survey; Updated Billing Manuals; Claims for HCPCS 2024 Procedure Codes were Suspending EOB 0000; Updates to Network Participation/Affiliations Available During Revalidation; PT/OT Providers: Satisfaction Survey; Pharmacy: Prescriber Tool Alternative Payment Model; HCBS LTSS Providers: Provisional Provider Payment; ColoradoPAR Program; Featured Resource: Revalidation FAQ; Sign Up for Provider Email Communications; Known Issue: Institutional Claims Denying EOB 0192.

Provider News & Resources - 02-05-2024  Issue 85 - This newsletter contains information on Did You Know? 2024 HCPCS Updates; Revalidation Requirements for Billing Providers; OPR: Enrollment Requirement; NEMT: Claim Attachment Requirements; NEMT: IntelliRide Reminder; Behavioral Health Stakeholder Webinar; Updated Billing Manuals; Known Issue: Professional Claims for DME Services Denying EOB 2861; Resolved Known Issue: Professional Claims for DME Services Suspending EOB 1512; Resolved Known Issue: Claims for Physical Therapy and Occupational Therapy Denying EOB 4211.

Provider News & Resources - 01-15-2024  Issue 84 - This newsletter contains information on HCBS: Career Resources for Direct Care Workers; 2024 Medicare Part A and Part B Deductible Amounts; 2024 Provider Enrollment Application Fee; BHA Coverage Type Not Eligible for Medicaid or CHP+; Requirements for Eyewear Providers; Updated Billing Manuals; Resolved Known Issue: Some Speech Therapy Claims were Denying for EOB 5550, 5551 and 5552.

Provider News & Resources - 01-08-2024  Issue 83 - This newsletter contains information on Did You Know? License Update Requirement; 2024 Provider Enrollment Application Fee; Claims for HCPCS 2024 Procedure Codes Suspending for EOB 0000; New System Error for Attachments in the Provider Web Portal; New Language Proficiency Field Available for Providers; HCBS: Money Follows the Person (MFP) Capacity Building Grant; Incorrect Speech Therapy (ST) Sessions in Provider Web Portal and Incorrect ST Denials; Immunization Rate Update; Pharmacist-Administered Vaccines; NOVAVAX COVID-19 Vaccines; Immunization Updates and Reminders; Updated Billing Manuals; Resolved Known Issue: Some Claims for Speech Therapy are Denying for EOB 5550, 5551 and 5552.