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Provider Services Call Center Virtual Agent Fact Sheet

Provider Services Contact Center Virtual Agent Fact Sheet

Last Updated: 05/22/25

 

The new Provider Services Contact Center Virtual Agent can answer multiple questions based on user inquiries without having to return to the main menu.
Note: The menu options changed on May 1, 2025, and entries used with the previous virtual agent (such as pressing 1) no longer work.
 

To use the virtual agent successfully, providers should:

  • Have the provider IDs, member IDs, claims IDs (Internal Control Numbers [ICNs]) and dates of service available for entry when the virtual agent asks for the information. 
    • All providers must enter the Health First Colorado Provider ID or the National Provider Identifier (NPI) when asked for ID verification. While an option is offered for providers who do not have an NPI or Health First Colorado Provider ID, enrolled providers must enter the ID. All providers will be asked to give their ID (spoken or entered by pressing numbers via the telephone) before the call is transferred to an agent.
  • Use two digits for the month, two digits for the day and four digits for the year in the following format: MM/DD/YYYY when asked for dates.
  • Say things such as “go back” to refine a search, “something else” to be presented with other options or “continue,” when necessary.
     

The virtual agent asks the caller what is needed, analyzes what is said, responds accordingly and can answer the following inquiries:

  • Member Eligibility – Providers can say many things, such as “Member Eligibility,” “Lock In” and “Coverage” to access the Member Eligibility detail. Providers will need to provide their NPI, a valid Member ID and, if applicable, a date of service. All benefit plans the member is eligible for will be read out to the caller. The caller can choose to hear more specifics about member eligibility for lock-in, Third Party Liability (TPL)/commercial insurance and managed care plans.  
  • Claim Status – Providers can access claims status detail by saying “Claim,” “Claim Status,” or “Payment,” as well as other claims-related statements. Providers must use an NPI (not the Health First Colorado Provider ID) for this option. A valid claim number is also required for this search. The status on a single claim with the Explanation of Benefits (EOB) associated with the claim will be read out to the caller.  
  • Claim History – Providers can search for details on a range of claims by providing a date range. The date range cannot exceed a 31-day date span. A claim number will not be needed for this search. 
  • Payment History– Providers can search for a range of payments by date of service. The date range cannot exceed a 31-day date span. 

The virtual agent will transfer the call to a live agent if the request cannot be supported.
 

Phrases to Reach a Live Agent
Providers can say key terms or phrases such as “EDI," "Prior Authorization," "Portal," "Other," “Agent” or "Supervisor” to be transferred to the appropriate Provider Services Contact Center queue. Key phrases that will route the caller to a live agent include:

  • Claims Information other than Claim Status: Use statements such as “pricing,” “revenue code,” “electronic visit verification,” “remittance advice”
  • Provider Web Portal: Use statements such as “portal,” “web portal,” “add a delegate”
  • Prior Authorization: Use statements such as “prior authorization,” “PA,” “PAR”
  • Password Inquiries: Use a statement containing the word “password”

Important Note: Caller will also be asked to opt-in or opt-out of a survey.