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OCTOBER 2026
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At Colorado Access, caring for you and your success is our top priority as you serve our shared members. This monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with us. |
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Benefits, Billing, and Code Updates |
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Recently Updated Billing Manuals and Fee Schedules
Reminder: The Department of Health Care Policy and Financing (HCPF) has clarified the previous guidance regarding the use of Box 19. Initially, it was believed that requiring all unlicensed and pre-licensed professionals to obtain an NPI for reporting in Box 19 would provide an effective way to track utilization. However, implementation challenges made this approach unworkable.
Providers reported that many billing systems could not capture information in Box 19, and some unlicensed and pre-licensed professionals were unable to obtain NPIs because appropriate taxonomy codes were not available for their roles. As a result, the Department discontinued the NPI and Box 19 requirements.
Please note that the Modifier U9 policy, effective July 1, 2026, remains in effect and should continue to be followed.
Review these policies here.
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Eligibility and Enrollment |
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Health First Colorado Eligibility Changes Due to H.R. 1
Colorado Access is working with HCPF to help providers and members understand and respond to eligibility changes resulting from H.R. 1 (the One Big Beautiful Bill Act). New federal rules will mostly affect members ages 19 to 64. Some lawfully present immigrants lost Health First Colorado (Colorado's Medicaid program) coverage on October 1, 2026. This includes refugees and asylees, people granted humanitarian paroles, and others. HCPF has initial data on the impact of the change to coverage for certain immigrants. Data shows that 4,150 members lost coverage, 1,492 members moved to Emergency Medicaid Services, and 298 members moved to state-only Cover All Colorado coverage. For details, see Health First Colorado’s website about changes to eligibility due to H.R. 1.
Letters have gone out to Medicaid expansion population members who will be subject to work requirements and six-month redeterminations starting in January 2027. You can view the letters that were sent here. Another round of those same letters will go out on October 30.
Information covered in these letters include:
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COA H.R. 1 MEDICAID CHANGES WEBINAR FOR PROVIDERS AND COMMUNITY PARTNERS
Colorado Access invites provider practices and community partners to join an upcoming webinar focused on H.R. 1 and its impact on Medicaid members and the organizations that serve them.
Date: Thursday, October 29th (NEW DATE)
Time: 11:30 a.m. – 1:00 p.m.
Format: Virtual (recording and presentation materials will be shared afterward)
Register now.
What We'll Cover
This session is designed to help practices better understand upcoming changes, prepare their teams, and connect members to available resources.
We encourage all interested providers and community partners to mark their calendars and join us for this important discussion. |
Training and Assistance |
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Colorado Access Behavioral Health Town Hall Meetings
Please join us for our monthly Behavioral Health Provider Town Hall Meetings, where we share updates, provide information and training, and answer your questions.
Register here for the Town Hall Meetings.
For questions, email clinical@coaccess.com. |
Supervision Requirements for Non-Licensed Providers
The Colorado Access Provider Manual has been updated to establish a maximum supervision ratio for peer or QBHA services. Providers must maintain a ratio of no more than one (1) licensed provider for every ten (10) peer/QBHA staff members under their supervision. Please review the updated Provider Manual and ensure your organization’s supervisory structure complies with this requirement.
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Programs to Support Members' Health
Colorado Access offers support to members to help manage their health and well-being, including care coordination, complex case management, self-management support tools, and text messaging programs. These programs are voluntary and available at no additional cost to eligible members. For more information, you can visit coaccess.com/members/health-programs.
Complex Case Management
Colorado Access offers Complex Case Management to members who have serious or long-term health problems and need more support. Members may be identified for the program through available health records or by referral. Members may be referred to the program by internal and external medical management programs, discharge planners, members, or caregivers. Providers can also refer members into the program by completing a referral form available at https://carecoordinationreferral.coaccess.com/. If the member is not eligible for the program, Colorado Access will help connect them to an alternative care coordination program.
To strengthen collaboration with providers, Colorado Access will notify providers via email if a member is actively involved in complex case management, as well as share the agreed-upon care plan. The email is sent to COA's primary contact for care management/care coordination.
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CHP+ Pharmacy Information
Colorado Access has Pharmacy resources and information for Providers available at Pharmacy Services & Formularies, including links to the formulary available online and through the prescriber portal. The formulary includes drug tier information as well as limits or restrictions, such as prior authorization, quantity limits, and step therapy requirements. Formulary updates are generally made at the first of each month and posted online. If there is a formulary change that impacts (or affects) one of your patients, both you and your patient will be sent a letter 30 days in advance notifying you of the change.
You will also find helpful information about Navitus Health Solutions, which manages our prescription drug benefits. Navitus reviews all requests for prescription drugs that require prior authorization, as well as non-formulary exceptions, quantity limit exceptions, and step therapy exceptions.
View prior authorization request forms and other helpful pharmacy resources on the website here.
The CHP+ Formulary changes on a monthly basis. View the recent updates that went into effect this past month here. |
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Clinical Criteria
Colorado Access provides access to the medical necessity criteria used in utilization management decision-making through its publicly available Clinical Criteria webpage: Health Research & White Papers | Colorado Access. This resource includes Colorado Access custom clinical criteria as well as access to InterQual criteria. To access InterQual criteria, you will have to create a One Healthcare ID by following website prompts. By making these criteria available online, Colorado Access enables members and providers to readily review the standards used to determine medical necessity and support authorization requests. |
News and Announcements |
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Interoperability Provider Information
On January 1, 2027, Colorado Access will launch new tools required by CMS Interoperability Rule 57-F. These tools will let providers securely share health information electronically. Providers must have an established treatment relationship with the member and follow all member consent requirements.
Providers can choose whether to participate. We will share more details about technical requirements, implementation support, and important dates as the work moves forward. Colorado Access is committed to improving care coordination, making it easier to share information, and protecting members’ privacy.
Questions may be directed to customer service at providernetworkservices@coaccess.com. |
Update to UM Coverage Hours-Effective October 25, 2026
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Effective October 25, 2026, Colorado Access Utilization Management has moved from 24/7/365 coverage to daytime coverage, seven days a week (Sunday–Saturday, including holidays) 8 am- 5 pm MT. The most important thing for providers to know: this does not change how or when you should submit prior authorization requests. Please continue to submit PARs as you do today, we will review all requests within our contractual timelines, including urgent preservice requests within 72 hours of receipt. If a member needs a higher level of care outside daytime hours (for example, an ED-to-inpatient admission), they can still be admitted to the appropriate level of care without a gap in access. This update affects staffing hours, not members' access to care.
- Verify member eligibility through the Colorado Access website or the HCPF eligibility portal.
- Providers who do not use third-party billers may use our secure authorization portal. Alternatively, complete a prior authorization request form available at our website, www.coaccess.com , and send it with appropriate clinical documentation to the fax number listed on the form. Incomplete forms will not be accepted.
- For more details, visit our Prior Authorization & UM Resources page.
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Prior Authorization Submission-Elimination of Email Submissions- Effective November 1, 2026
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Effective November 1, 2026, Colorado Access will no longer accept prior authorization requests, initial, concurrent, or retrospective, submitted via email.
- Verify member eligibility through the Colorado Access website or the HCPF eligibility portal.
- Providers who do not use third-party billers may use our secure authorization portal. Alternatively, complete a prior authorization request form available at our website, www.coaccess.com and send it with appropriate clinical documentation to the fax number listed on the form. Incomplete forms will not be accepted.
- For more detail, visit our Prior Authorization & UM Resources page.
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Prior Authorization Submission-Submission Reminder
- All requests for services must be submitted with a current prior authorization (PAR) form, along with clinical support (documentation and assessments, as applicable), in order to be processed.
- Please find the prior authorization request form on our website www.coaccess.com.
- Note: Requests submitted through our Authorization Portal do not require a PAR form. Using the portal is the quickest and easiest way to submit authorization requests, and will reduce response time so you receive a decision faster.
- To access the Provider Authorization Portal, visit: Provider Authorization Portal Login
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Lead Poisoning Prevention Week: October 15 - 31
As Lead Poisoning Prevention Week approaches, thank you to the practices already making lead testing a routine part of well-child care. There is no safe level of lead in a child's blood, and the effects of lead exposure on learning and behavior can't be reversed, so early testing and finding the source matter.
In 2025, 1.5% of tested Colorado children under age 3 had a blood lead level at or above the reference value (3.5 µg/dL). Yet statewide, only 36% of Colorado children on Medicaid had been tested at least once at 12 or 24 months.
Health First Colorado and CHP+ children need a blood lead test at 12 and 24 months, at no cost to families. Together, we have a real opportunity to increase screening rates, identify children at risk, and help prevent the lifelong effects of lead exposure.
To learn more, take the ECHO On-Demand Childhood Lead Poisoning Prevention training from The Care Collaborative at CU Anschutz and CDPHE. It's four online modules you can watch at your own pace. For additional provider resources, visit CDPHE's lead page for healthcare providers. |
October is Breast Cancer Awareness Month
October is Breast Cancer Awareness Month—a timely reminder that routine screening can detect breast cancer early, often before a lump can be felt or other symptoms appear. Earlier detection can make breast cancer easier to treat and may improve outcomes.
For people at average risk, the U.S. Preventive Services Task Force recommends a mammogram every two years from ages 40 through 74. Individual screening needs may vary based on personal or family history, breast density, previous breast conditions, or other risk factors. Patients should talk with their health care provider about when to begin screening and how often to be screened.
For Providers: Promote Timely Screening
Providers play an important role in helping patients understand when breast cancer screening is due and why it matters. Use routine visits and outreach opportunities to take the following actions:
- Use care-gap reports or electronic health record reminders to identify patients who are due or overdue for mammography.
- Explain the benefits and potential limitations of screening in plain language. Support shared decision-making based on the patient’s age, history, risk factors, and preferences.
- Ask about barriers such as transportation, scheduling, language access, or fear, and connect patients with screening and navigation resources when available.
- Use reminders and follow-up outreach to help patients complete referrals, ensure results are documented, and support timely evaluation of abnormal findings.
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