MedicaidAdministrativeMedium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300498 - 09/2023)
Colorado Medicaid·CO·Provider Bulletin
Effective date
Nov 1, 2023
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) has issued a comprehensive provider bulletin with multiple updates affecting billing procedures, prior authorization requirements, and administrative processes. Key changes include DRA compliance requirements due November 1, 2023, updates to inpatient hospital review programs, and new secondary medical necessity review processes for substance use disorder denials.
Action Required
By November 1, 2023: Providers receiving $5+ million annually in Medicaid payments must complete and email DRA Declaration to hcpf_DRAAct2005@state.co.us with fraud/waste prevention policies documented. Billing team must ensure current contact information in Provider Web Portal to receive DRA emails. Update billing procedures for CHP+ members to bill MCOs directly after enrollment date, and bill Gainwell Technologies for interim periods. Laboratory providers must obtain prior authorization for CPT code 81220.