Medicare AdvantageAdministrativeMedium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200477 - 04/2022
Colorado Medicaid·CO·Provider Bulletin
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) updated billing requirements for Medicare Advantage claims and provider responsibilities for verifying member eligibility within 365 days. Key changes include proper billing field usage for Medicare Advantage plans and mandatory NPI reporting for ordering providers effective July 1, 2022.
Action Required
By July 1, 2022: Billing team must update claim submission procedures to report Medicare Advantage plan information in Medicare fields (not TPL fields) for Colorado Medicaid crossover claims. Update professional claims to include ordering provider NPI in field 17.b (paper) or loop 2420e with qualifier DK (electronic). For institutional claims, include ordering provider NPI in Attending Provider field (#76) or Other ID fields (#78/#79). Implement process to verify Health First Colorado eligibility within 365 days through Provider Web Portal, batch verification, or member contact to avoid timely filing denials.