MedicaidPrior AuthMedium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100463 - 05/2021)
Colorado Medicaid·CO · OB-GYN, Family Medicine, Internal Medicine +4 more·Provider Bulletin
Effective date
Jul 1, 2021
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) has updated their claims processing procedures - denied claims should now be corrected and resubmitted as new electronic claims rather than sent for reconsideration. The policy also updates billing requirements for multiple infant deliveries, requiring modifier 59 instead of modifier 22 effective May 1, 2020, and implements prior authorization requirements for select physician-administered drugs starting July 1, 2021.
Action Required
By July 1, 2021: Update billing system to require prior authorization for specified physician-administered drugs (J-codes listed in policy) for Colorado Medicaid patients. Immediately: Change claim resubmission workflow - correct and resubmit denied Colorado Medicaid claims electronically as new claims instead of sending reconsideration requests. For obstetrical billing: Use modifier 59 (not modifier 22) for multiple infant deliveries and follow updated billing guidelines for cesarean and vaginal deliveries. Contact Provider Services at 1-844-235-2387 for claim correction guidance.