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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400509 - 06/2024)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Health First Colorado claims are paid only when the billing, attending, rendering and referring provider IDs are actively enrolled and revalidated, and denied claims are to be corrected and resubmitted electronically as new claims. Claims requiring an OPR or attending provider begin denying effective July 1, 2024 when that provider is missing or not enrolled, and nursing facility claims with a missing or not enrolled attending provider are denied under the same EOB 1997 rule. Fee-for-service rates increase 2.0% for dates of service starting July 1, 2024, with targeted rate increases for listed services, and claims billed and paid at a lower rate cannot be adjusted up under the lower-of pricing logic.
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What to do
Action · 14 steps
01Already effective July 1, 2024 for OPR and attending claims: billing team confirms every OPR and attending provider on a claim is actively enrolled as an individual with Health First Colorado, and places the OPR NPI in CMS 1500 Field 17b or UB-04 Fields 76, 78 and 79.
02Claims for audiology, home health, outpatient PT and OT, outpatient speech therapy, pediatric personal care, and radiology and imaging services with a missing or not enrolled OPR provider post EOB 1997.
03Nursing facility claims requiring an attending physician are denied under EOB 1997 if the attending provider is missing or not enrolled.
04Already effective May 1, 2024 for HCBS claims: billing team adds modifier HX to HCBS services provided in the City and County of Denver where required, and adjusts any claims billed without it.
05Billing team corrects and resubmits denied claims electronically as new claims, since denied claims do not need a reconsideration request.
06Billing team keeps the Health First Colorado Provider Web Portal account current with legal name, contact name, email, phone and all addresses for HCBS and long-term care providers.
07Hospital specialty drugs such as J0225, J9286 and the CAR-T and other HCPCS codes listed need a member-specific PAR submitted directly to the Department and approved before administration.
08Hippotherapy coverage is anticipated to be implemented beginning July 1, 2024: providers may bill speech, physical and occupational therapy services using existing open codes, and the AHA guidance applies to choosing among CPT codes 97110, 97112, 97530, 97116, 97535, 92507, 92508, 92526, 97129 and 97130.
09Billing team bills corneal crosslinking with CPT 0402T, and riboflavin ophthalmic solution with J2787, as covered benefits.
10Billing team bills Extencilline under HCPCS J0561 using the HCPCS/NDC crosswalk in Appendix X.
11Pharmacy and medication-prescribing providers check the PDL classes with drugs moving to preferred or non-preferred status effective July 1, 2024.
12Behavioral health providers offering ASAM Level 2.5 partial hospitalization contact MCEs regarding contracting and reimbursement, since coverage begins July 1, 2024.
13NEMT providers must be credentialed through Transdev and revalidate enrollment Previously due September 30, 2024 (date passed; verify current applicability), and the credentialing certificate is submitted with the revalidation application; these past deadlines should be checked for current applicability.
14Providers must not offer gift cards, cash or cash-equivalent items, and gifts above $15 per item or $75 per beneficiary per year are not allowed under HCPF OM 24-015.
Codes mentioned
J0218J0225J0567J1303J1413J2326J3399J7352J9229J9286J9348Q2041Q2042Q2053Q2054Q2056J0561J278797110971129753097116975359250792508925269712997130
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400509 - 06/2024)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
See all Colorado Medicaid changes →Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000455 - 11/2020)MediumEffective Jan 1, 2021 · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2300497 - 08/2023)MediumNo effective date · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2500530 - 10/2025)HighEffective Oct 1, 2025 · Provider BulletinHealth First Colorado (Colorado's Medicaid Program) News and Updates (B2600542 - 09/2026)HighEffective Oct 1, 2026 · Provider BulletinBrowse every Colorado Medicaid change in the policy list
Related policy hubs
Colorado Medicaid policiesCO policy changesGeneral PracticeAudiologyRadiologyPhysical TherapyOccupational TherapySpeech TherapyPharmacyPsychiatryOncologyHematologyOphthalmologyCode J0218Code J0225Code J0567Code J1303Code J1413Code J2326Code J3399Code J7352Code J9229Code J9286Code J9348Code Q2041Code Q2042Code Q2053Code Q2054Code Q2056Code J0561Code J2787Code 97110Code 97112Code 97530Code 97116Code 97535Code 92507Code 92508Code 92526Code 97129Code 97130