MedicaidAdministrativeHigh impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100465 - 07/2021)
Colorado Medicaid·CO·Provider Bulletin
Effective date
Jul 1, 2021
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) implemented multiple changes effective July 1, 2021: CHP+ members automatically enrolled in managed care requiring claims to be billed to MCOs instead of Gainwell, 2.5% rate increases across most services, and new prior authorization requirements for implantable neurostimulators (L8687).
Action Required
Immediately for Colorado providers: 1) For CHP+ members, verify managed care assignment and bill MCO instead of Gainwell for services after June 30, 2021. If eligibility predates MCO assignment, bill Gainwell. 2) Update prior authorization requirements for HCPCS L8687 (implantable neurostimulator) - all claims require prior auth through ColoradoPAR. 3) Use HCPCS B9998 + U1 modifier for cholesterol supplements with prior auth. 4) Use HCPCS A9286 for EPSDT wipes with prior auth. 5) Bill usual and customary charges to receive 2.5% rate increases for services starting July 1, 2021.