MedicaidAdministrativeHigh impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600542 - 09/2026)
Colorado Medicaid·CO·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Sep 2, 2026
Summary
This is a comprehensive Health First Colorado (Colorado Medicaid) provider bulletin containing multiple policy updates effective September 2026, including provider affiliation requirements, change of ownership procedures, DRA compliance documentation deadlines, license verification standards, and specialty-specific updates across behavioral health, hospitals, pharmacy, and women's health services. Billing teams must address multiple concurrent requirements including claim denial prevention for inactive licenses, DRA documentation submission by November 2, 2026, and various service-specific prior authorization and billing updates.
Action Required
REQUIREMENTS:
1. By August 1, 2026 (IMMEDIATE): Billing team must verify that all provider licenses are current and active in Health First Colorado system. Any claims with dates of service on or after August 1, 2026, will be denied with EOB 3385 if licenses are not updated. Action: Access Provider Web Portal, submit Provider Maintenance Request for any expired or missing licenses, and resubmit all previously denied claims once updates are completed.
2. By November 2, 2026: Billing team and practice leadership must identify if organization meets DRA Section 6032 threshold (receives $5M+ annual Medicaid payments). If subject to DRA: Complete and email signed DRA Declaration with all NPIs, Service Location IDs, and Tax IDs, plus copies of (a) fraud/waste/abuse policies, (b) employee handbook section on false claims laws, (c) whistleblower protection rights, and (d) practice-specific discussion of policies to hcpf_draact2005@state.co.us. Failure to submit results in compliance violation.
3. Within 35 days of any change: If practice experiences ownership change, EIN change, or material application information change, notify Department of Health Care Policy and Financing and complete Change of Ownership (CHOW) form for applicable provider types (Home Health PT 10, Hospice PT 50, Hospital PT 01, IHS Pharmacy PT 62, Nursing Facilities PT 20/21, Pharmacy PT 09, Psychiatric Hospital PT 02). For other provider types, old provider must disenroll via Provider Web Portal and new provider must submit new enrollment application. New business owner assumes all liabilities.
4. Immediately: Billing team must verify all provider affiliations are current in system. If claims receive EOB 3110 ("rendering provider is not a group member"), update affiliations immediately. Affiliations take up to 8 days for approval. During extended grace period, correct affiliations to prevent future claim denials.
5. Ongoing: All providers using trading partners and those in ColoradoPAR program must monitor for Electronic Data Interchange vendor transition details and new Supported Employment provider training requirements (details in full bulletin pages 6-26).
CONSEQUENCES: Claims will be denied for inactive licenses (EOB 3385), rendering provider not affiliated (EOB 3110), and DRA non-compliance may result in program sanctions.