MedicaidAdministrativeHigh impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2500531 - 11/2025)
Colorado Medicaid·CO·Provider Bulletin
Effective date
Nov 3, 2025
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) is implementing stricter claims processing requirements where RAEs and MCOs will begin denying claims from providers who are not properly enrolled or whose claim information doesn't match their enrollment records. The rollout begins November 3, 2025 with flags only, then transitions to actual claim denials starting December 1, 2025 through January 5, 2026.
Action Required
Before December 1, 2025: Billing team must verify all provider enrollment information in the Provider Web Portal matches exactly what is submitted on claims, including correct NPI and Taxonomy Codes in proper fields. Contact your assigned RAE/MCO if you receive notification of being impacted. Failure to correct enrollment mismatches will result in claim denials starting December 1, 2025 (Colorado Access) and January 5, 2026 (other plans).