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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400511 - 08/2024)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Providers cannot bill Health First Colorado members for services covered by Health First Colorado, for services rendered but not prior authorized due to lack of information on a PAR, for the denied portion of a PAR, or for system-related denials such as billing errors or timely filing. Claims must be submitted and received within 365 days of the date of service. CPT codes 87505 and 87506 are expected to be covered benefits effective September 1, 2024 and require a PAR submitted through Acentra's Atrezzo portal.
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What to do
Action · 14 steps
01Already effective July 1, 2024 for member billing: billing team does not bill members for covered services, verifies eligibility on every date of service through the Provider Web Portal, virtual agent, Batch 270 or a clearinghouse, and does not bill members when PAR denials are for lack of information.
02Billing team collects co-pays only from members with primary Medicaid coverage, and sends any collected fees back to a member who gains retroactive eligibility, minus required co-pays, before billing Health First Colorado for covered services.
03Billing team does not send overdue Health First Colorado member accounts to collection agencies unless the service is non-covered and the member has broken a written payment agreement.
04Billing team submits claims within 365 days of the date of service, since correspondence with the fiscal agent is not proof of timely filing.
05Lab team submits a medical PAR for CPT 87505 and 87506 through Acentra's Atrezzo portal before those codes are billed as covered from September 1, 2024; check current applicability of that date rather than completing it.
06Billing team attaches the required trip documentation to NEMT claims for A0425 or S0209 above 52 units, since suspended claims are denied without it.
07Billing team attaches a digital copy of the Verification Form for Transportation Services More Than 25 Miles to each NEMT claim submitted through the Provider Web Portal; the form is valid for 90 days for recurring appointments.
08Already effective April 1, 2024 for DMEPOS: claims with a different prescribing provider than the physician, physician assistant or nurse practitioner stated in the DMEPOS Billing Manual are denied.
09Billing team stops billing bypass modifier CR for dates of service on or after September 1, 2024.
10Already effective July 1, 2024 for DME manual pricing: invoice-paid claims are reimbursed at actual acquisition cost plus 24.06%, and MSRP-paid claims at MSRP less 13.78%, and claims with lower submitted charges need adjustment.
11Already effective July 1, 2024 for ambulatory surgical centers: claims billed with a lesser submitted charge must be adjusted because the lower of billed charges applies.
12Billing team submits the 2024 HCBS Provider Attestation Form and 2024 Direct Care Worker Wage Attestation Form Previously due August 31, 2024 (date passed; verify current applicability); HCBS providers that do not submit are posted publicly and claim payment suspensions start September 1, 2024.
13Doulas (Provider Type 79) are a covered benefit effective July 1, 2024, and enrollment and billing guidance is on the Doulas web page.
14APR-DRG version 40 implementation is postponed until October 1, 2024.
Codes mentioned
8750587506A0425S0209
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400511 - 08/2024)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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