Revalidation

What can providers do now to prepare?

• Ensure each National Provider Identifier (NPI) for Health First Colorado is also enrolled with Medicare, for providers who bill Medicare.
• Obtain a new NPI prior to revalidating, if needed. House Bill 18-1282 requires newly enrolling and currently enrolled organization healthcare providers (not individuals) to obtain and use a unique NPI for each service location and provider type enrolled in the Colorado interChange.
• Visit the Colorado NPI Law web page for more information.
• Ensure all data and contact information in each enrollment profile is correct prior to revalidation. Refer to the Special Revalidation Newsletter III for specific information for billing groups and rendering providers. Contact the Provider Services Call Center if the Provider Web Portal log-in credentials need to be reset for the provider to access the Web Portal. Refer to the Provider Maintenance - Provider Web Portal Quick Guide located on the Quick Guides web page for step-by-step instructions on updating provider affiliations and contact information.
• Ensure that employees who have left a provider group no longer have Web Portal access for information such as revalidation, claims, eligibility and banking updates. Providers must set the status to inactive for any delegates no longer in the group by logging into the Web Portal, clicking on Manage Accounts, and clicking the Add New Delegate/Office Staff tab. Refer to the Delegates Provider Web Portal Quick Guide located on the Quick Guides web page for more information.

What do providers need to know?

• Review the Revalidation Resources and Revalidation Newsletters section box above for more information on the revalidation process.
• Refer to the Revalidation Quick Guide located on the Quick Guides web page for more information on completing the revalidation application through the Provider Web Portal.
• Providers will be revalidated on a continuous, rolling 5-year schedule.
• Providers with multiple locations will not have to revalidate all sites at once unless all the locations were approved at the same time. Email notices will be sent separately for each location.
• Each provider will be notified via email six months in advance of their revalidation deadline. The deadline is based on the date the enrollment application was approved.

What information can be updated through revalidation?

Some information will be auto-populated on the revalidation application, so not all sections are required to be completed. Providers should verify all the data in the provider's enrollment profile is correct and up-to-date prior to revalidation.

The table below displays what information can be updated through the revalidation application versus what content can be updated through a Provider Maintenance request separately in the Provider Web Portal.

* The Provider Maintenance Update column is not a conclusive list of all items that can be updated through a Provider Maintenance request.