MedicaidAdministrativeHigh impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400506 - 03/2024)
Colorado Medicaid·CO·Provider Bulletin
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) updated multiple billing requirements including mandatory attending physician NPIs for institutional claims and ordering/prescribing/referring (OPR) provider NPIs for professional claims. Claims missing these required NPIs will be denied with specific EOB codes.
Action Required
Immediately: Billing team must verify all institutional claims (UB-04) include attending physician NPI in Field 76 for dialysis, FQHC, home health, hospice, IHS, nursing facilities, PRTF, and RHC services. Verify all professional claims (CMS-1500) include OPR provider NPI in field 17b for audiology, DME, lab, radiology, pediatric personal care, and therapy services. Ensure all referenced NPIs are actively enrolled with Health First Colorado. Claims without required NPIs will be denied with EOB codes 1390 or 1997.