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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600538 - 05/2026)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Provider licenses on file with Health First Colorado must be active on the date of service, and claims for providers with expired licenses will deny for EOB 3385 effective May 18, 2026. Pediatric Long-Term Home Health services require prior authorization for all new and existing members effective May 4, 2026, with full enforcement beginning June 1, 2026. The notice also covers vaccine counseling codes (90482, 90483, 90484), the Mircera routine dialysis drug designation effective May 1, 2026, updated mechanical stretching device criteria effective June 1, 2026, and Pediatric Behavioral Therapy change of provider forms for CPT 97151 effective June 1, 2026. This is from a May 2026 issue, so check current applicability for each date before acting.
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What to do
Action · 25 steps
01REQUIREMENTS: Already effective May 18, 2026: Confirm that each provider's license on file with Health First Colorado is active, since claims for providers with expired licenses will deny for EOB 3385 (Provider license not active on date of service).
02Update licenses in the Provider Web Portal through a Provider Maintenance Request, using the Update Licenses and CLIA Quick Guide, and resubmit previously denied claims once license updates are completed.
03Already effective May 4, 2026: Submit prior authorization requests (PARs) through the Atrezzo Provider Portal for all new and existing members receiving Pediatric Long-Term Home Health services, including PT, OT, speech therapy, skilled nursing (RN/LPN) and CNA services.
04Services rendered without an approved PAR may be subject to claim denial or nonpayment beginning June 1, 2026, when PAR compliance is fully enforced.
05Already effective June 1, 2026: When a Pediatric Behavioral Therapy provider submits a PAR for CPT 97151 for a member who already has an active PAR with another provider, submit a completed Change of Provider form from the Provider Forms web page under the PAR Forms section, or the PAR will be pended back.
06Already effective June 1, 2026: Mechanical stretching device requests (HCPCS E0808, E1800-E1808, E1810-E1816, E1818, E1822-E1823, E1825-E1832, L3900 and L3901) are reviewed under updated criteria in the DMEPOS Billing Manual.
07Submitted documentation must include a signed order, a face-to-face visit with a physician addressing the specific joint concern within the prior four to six months, and an occupational or physical therapy evaluation from within the prior four months.
08Acentra PAR changes in effect since January 2026: pends for additional information are now seven calendar days, additional pends on the same PAR will not be extended, and all information requested in the initial pend must be supplied or the PAR will result in a technical denial.
09Expedited PARs cannot be pended, so include all documentation with the initial submission.
10Clearinghouses or billing agents that send X12 batch files must make sure the vendor knows about the EDI platform change to Edifecs, including the new trading partner agreement and the Move-It FTP server for X12 file exchanges, and trading partners currently using the Provider Web Portal should switch immediately to that FTP server.
11Keep contact information current so the training invitation is received.
12Effective May 1, 2026: Report Mircera (epoetin beta) as a Routine Drug for Dialysis using J0887 and J0888, per the Dialysis Billing Manual.
13Bill CPT 90482, 90483 or 90484 for visits in which providers counsel about the importance of vaccination, and do not bill the counseling code and the vaccine administration code on the same date of service when the administration code is inclusive of counseling.
14CPT G0310 through G0315 will no longer be reimbursed for dates of service after June 30, 2026.
15Already effective April 29, 2026: IRSS claims deny when a CNA service has already been reimbursed on the same date of service, so review member service plans with case managers and coordinate so CNA and IRSS services are not submitted for the same member on the same dates of service.
16Ensure all providers listed on a claim are enrolled with the third-party liability (commercial) insurer or Medicare, as well as Health First Colorado, if either covers the requested equipment.
17Effective May 15, 2026: Physician signature on an initial outpatient PT, OT, speech therapy or audiology Plan of Care is no longer required when there is an existing physician order or referral and the therapist keeps documentation that the Plan of Care was delivered to the physician office within 30 days of completing the initial evaluation.
18Recertification signature requirements are unchanged.
19Effective May 1, 2026: Use the new Managed Care Provider Escalation Request Form link on the Provider Contacts web page and update records accordingly.
20Prescribers who believe they were erroneously excluded from the LexisNexis prescriber database, or who want to opt back in, may email privacydesk@lexisnexisrisk.com with their NPI, DEA number and practice address, and processing may take up to ten days.
21Pharmacies may see more claim denials for prescriber validation reject codes.
22Lactation Support Services (S9443) may be billed under existing enrollment by eligible provider types with advanced lactation training, and providers must keep a current lactation certification (IBCLC, CLC or CLE) and submit it through the Provider Web Portal.
23Already effective July 1, 2026: Directed payments for behavioral health essential safety net services in a bedded facility are discontinued, while Mobile Crisis Response and Opioid Treatment Program directed payments remain.
24H0011 rates were misaligned in MMIS, and no claim adjustments will be necessary.
25Base wage reporting agencies should update contact information in the Provider Web Portal Previously due June 1, 2026 (date passed; verify current applicability).
Codes mentioned
97151904829048390484G0310G0311G0312G0313G0314G0315J0887J0888E0808E1800E1808E1810E1816E1818E1822E1823E1825E1832L3900L3901S9443H0011
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600538 - 05/2026)
hcpf.colorado.gov · Always check the source before changing claims.
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Related policy hubs
Colorado Medicaid policiesCO policy changesFamily MedicineGeneral PracticeInternal MedicinePediatricsPhysical TherapyOccupational TherapySpeech TherapyAudiologyPharmacyNephrologyPsychiatryCode 97151Code 90482Code 90483Code 90484Code G0310Code G0311Code G0312Code G0313Code G0314Code G0315Code J0887Code J0888Code E0808Code E1800Code E1808Code E1810Code E1816Code E1818Code E1822Code E1823Code E1825Code E1832Code L3900Code L3901Code S9443Code H0011