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MARCH 2026 |
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At Colorado Access, caring for you and your success is our top priority as you serve our 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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Residential Treatment Services After Incarceration
People released from incarceration can transition directly to substance use disorder (SUD) residential treatment. There are no Medicaid coverage restrictions that prevent this direct transition upon release, regardless of incarceration time. Health First Colorado (Colorado’s Medicaid program) covers the full continuum of care as outlined by The American Society of Addiction Medicine (ASAM). Learn more on the HCPF SUD Benefits webpage.
The person must still meet medical necessity criteria for SUD residential services. Jails and prisons that want to connect discharging people with this service should connect with us at Colorado Access to coordinate on a transition plan. |
Qualified Residential Treatment Program (QRTP) and Psychiatric Residential Treatment Facility (PRTF) Services
Starting July 1, 2026, medically necessary QRTP, PRTF, and Out-of-state High Intensity Residential Treatment (OHIRT) services for youth in the custody of county child welfare/departments of human services (CW/DHS) or the Division of Youth Services (DYS) will be covered under the capitated behavioral health benefit and reimbursed by the Regional Accountable Entities (RAEs).
Historical policy prohibited RAEs from paying for residential behavioral health treatment for youth in the custody of county CW/DHS or DYS. A 2018 statutory change removed authority for this “carve out.” The Colorado Department of Health Care Policy and Financing (HCPF) has elected to include residential services for the child welfare population into the RAE capitated benefit.
Starting in March of 2026, HCPF will hold monthly office hours to answer provider questions in preparation for this transition.
QRTP and PRTF office hours:
Please register for office hours and include what question(s) would you like addressed during the office hours so that HCPF staff can prepare accordingly. |
Electroconvulsive Therapy (ECT) Reimbursement Policy Changes Delayed
Changes that HCPF proposed to the ECT reimbursement policy will not be implemented in April, as originally planned. Implementation is delayed so HCPF can gather more input.
The proposed changes concern (1) incorporating ECT-related anesthesia into the reimbursement rate for ECT and (2) no reimbursement for ECT outside of per diem payments for inpatient psychiatric services.
Contact hcpf_bhbenefits@state.co.us with any questions. |
Abortion Coverage
There are changes in coverage of abortion-related services in compliance with SB25-183 for the following eligibility categories, effective for dates of service beginning January 1, 2026:
Approved abortion codes listed below will be reimbursed with state-only funds, regardless of circumstance. Members will not be subject to deductibles, copayments, or coinsurance for these services and may not be billed for these services (CO Rev Stat §25.5-4-301).
If you are a CHP+ provider, submit your claims to Colorado Access, your managed care organization, for manual reconciliation reimbursement.
You must submit separate claims for any services not specific to abortion care; non-abortion services must not be included on the abortion-related claim and may be denied and subject to recoupment (claw back) if improperly bundled.
Elective abortions are identified by diagnosis code Z33.2; no additional documentation is required for reimbursement of elective abortion-related services. Current system restrictions limiting abortion coverage to cases of incest, rape, or life endangerment are removed, effective January 1, 2026.
Beginning January 1, 2026, you are no longer required to append Modifier 52 to CPT code S0199 to identify telemedicine services that were used to deliver any component of the abortion bundle. Telemedicine may be used for one or more components of S0199 (e.g., patient counseling, follow-up consultation, or confirmation of pregnancy). The Department of Health Care Policy and Finance (HCPF) will release future guidance regarding appropriate telemedicine informational modifiers for claim submission.
Treatment for Non-Viable Pregnancy
HCPF will continue to seek federal match regarding treatment related to nonviable pregnancies. No documentation is required for reimbursement on non-viable pregnancy treatment. When a member receives treatment for a non-viable pregnancy condition, an appropriate diagnosis code (listed below) is required:
Abortion and Pregnancy-Related Procedure Codes
The following CPT codes are covered for abortion and pregnancy-related services: 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 01964, 01965, 01966, 58120, 59100, 59812, 59830, S0199, S0190, S0191
Surgical Procedure Codes: 10A07Z6, 10A07ZZ, 10A07ZW, 10A00ZZ, 10A07ZX, 10A08ZZ,
The Obstetrical Care Billing Manual reflects these changes as of January 1, 2026.
Questions?
About provider enrollment: Call the HCPF Provider Services Call Center. |
Special Provider Bulletin for HCPCS Updates
Health First Colorado (Colorado’s Medicaid program) implemented the annual 2026 Healthcare Common Procedure Coding System (HCPCS) additions, deletions and changes effective for dates of service on or after January 1, 2026. See the Special Provider Bulletin for more information. |
Report Corrections to the Child Health Plan Plus Fee Schedule
To report missing or incorrect information in the Child Health Plan Plus (CHP+) fee schedule, please use HCPF’s CHP+ Fee Schedule Correction Form.
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Physician-Administered Drug Prior Auth Updates
Effective January 1, 2026, the following physician-administered drug codes now require prior authorization: J1442, J2506, J9312, Q5101, Q5108, Q5111, Q5122, Q5125, Q5127, Q5130.
Effective April 1, 2026, Asceniv (human immune globulin) (HCPCS code J1554) will require trial and failure of two prior immune globulin therapies.
For these updates and a full list of physician-administered drugs that require prior authorization, see Appendix Y: Physician Administered Drug Medical Benefit Prior Authorization Procedures and Criteria. Contact HCPF_PAD@state.co.us with questions. |
Doula Services
Doula services are covered for pregnant members of CHP+ and Health First Colorado (Colorado’s Medicaid program). Please let your pregnant and postpartum patients and clients know.
If you are interested in becoming a doula, please note that the application forms have changed. The updated forms are on the Health First Colorado Provider Forms web page under the “Provider Enrollment & Update Forms” drop-down menu. |
Claims Tips |
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Maintain Updated License with HCPF to Avoid Claims Issues
All enrolled providers must maintain current and active licensure that matches state regulatory records. This ensures compliance with state requirements and supports efficient claims processing, credentialing, and revalidation.
When a license is not updated in the system, providers may experience claim rejections, denials, or recoupments; delays in reimbursement; and problems with credentialing and revalidation.
Update your professional licenses promptly in the state Provider Web Portal. Directions are available on the Update Licenses and Clinical Laboratory Improvement Amendments (CLIA) webpage.
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Training and Assistance
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Colorado Access Behavioral Health Town Halls
Please join us for our monthly Behavioral Health Provider Town Hall Meetings, where we share updates, provide information and training, and answer your questions. The next one is on Thursday, March 12, at 12 p.m.
Register for the Town Hall Meetings here.
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ECHO Series: Endocrine Explained for Prescribing Providers
A new ECHO series for primary care providers will focus on endocrinology conditions encountered in the primary care setting. Sessions will equip primary care clinicians with the knowledge to quickly recognize, evaluate, and start managing the endocrine problems they see most, before referral is even needed. Sessions include brief didactic presentations by endocrinology experts and discussion of participant-submitted cases. Participants are highly encouraged to bring de-identified patient cases for group discussion and expert consultation.
The series will be on Tuesdays from 12:00 to 1:00 p.m. from April 7 to June 9.
Sign up for the Endocrine Explained series. |
ECHO Series: Pediatric Suicide Prevention: A Practical Care Pathway for Primary Care
This three-session ECHO series supports primary care providers in the outpatient setting by offering a practical suicide prevention care pathway based on the Zero Suicide framework. Three sessions cover the implementation of an evidence-based screening tool, assessment, safety planning, lethal means safety and ongoing management follow-up plan to support youth experiencing suicidal ideation. Resources and referral information will be shared throughout the series. The audience is primary care and behavioral health providers working with youth in an outpatient primary care setting and providing direct patient care.
The series will be on Wednesdays from 12:00 to 1:00 pm from April 22 to May 6.
Sign up for the Pediatric Suicide Prevention series. |
Open Office Hours for Doula and Lactation Questions
HCPF will host open office hours to assist doula and lactation providers with enrollment and claims-billing questions.
Please register for office hours you wish to attend. If your schedule changes, you can return to the same link to add another event:
Please email hcpf_maternalchildhealth@state.co.us with any questions. |
Opportunities to Give Feedback
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American Society of Addiction Medicine (ASAM) Criteria 4th Edition Transition: Community-Focused Resources and Events
Big changes are coming to behavioral health services. Residential withdrawal management, also called “social detox” services, are changing. The Behavioral Health Administration (BHA) and HCPF want to ensure you know what’s happening and can get involved in this change process.
BHA needs your feedback on the proposed changes to ASAM 4th Edition Aligned BHA Provider Rules 2 CCR 502-1. To preview the aligned rule drafts, and sign up for upcoming community engagement opportunities, visit the BHA’s Laws and Rules webpage.
You may also provide feedback through this BHA Rule Feedback Form, or through email at cdhs_bharulefeedback@state.co.us. Community feedback is accepted through 5:00 p.m. on March 31, 2026. |
Mental Health Parity: Request for Public Comment
HCPF has begun work on the annual Mental Health Parity and Addiction Equity Act (MHPAEA) Report to assess the compliance of the Medicaid benefit with mental health parity laws. HCPF is gathering stakeholder insights and experiences related to mental health parity that will be used to design the mental health parity analyses and inform an annual report.
Submit written comments through this form until March 16. The purpose is to collect feedback from stakeholders; HCPF will not respond to submitted comments. For more information, visit the Parity webpage. |
News and Announcements
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Colorado Access Provider Portal: No Third-Party Access
Third-party entities, such as billing companies, consultants, and other external representatives, are not authorized to create accounts or access the provider portal on behalf of a provider or facility. The portal is a contracted software system intended exclusively for use by authorized personnel within the provider organization.
Because the portal contains protected health information (PHI), allowing a third party to create or access a provider’s account could result in a potential HIPAA violation. For this reason, we cannot create accounts for or grant portal access to individuals who are not directly employed or authorized by the provider organization.
The designated Provider Administrator for your organization can add and manage user accounts. If your Provider Administrator requires assistance with user management or resetting administrator credentials, we are happy to provide support. Please feel free to contact the Provider Network Services team at ProviderNetworkServices@coaccess.com. |
Provider Credentialing Rights
All providers have the right to review information submitted to support their credentialing application, including information obtained from outside sources (e.g. malpractice insurance carriers, state licensing boards). Colorado Access is not required to make available references, recommendations, or peer-review protected information.
Providers have the right to correct erroneous information such as actions against your license, malpractice claims history, or board certification status. When correcting erroneous information is through the verification process, credentialing staff sends up to three email attempts over 21 business days. Information may be sent back to the individual who made the initial outreach, or responses and documentation may be sent to credentialing@coaccess.com email. All documentation and communication are saved in the provider’s electronic credentialing folder. Colorado Access is not required to reveal the source of information that was not obtained to meet verification requirements or if federal or state law prohibits disclosure.
All providers have the right to receive the status of their credentialing or recredentialing application, upon request. The requests can be sent to credentialing@coaccess.com and an approval/effective date will be provided, or the provider will be notified of the missing information needed to complete the primary source verification process.
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2026 CAHPS Survey: Help Us Hear from Your Patients
Starting mid-December, some of your patients may be randomly selected to participate in the 2026 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This anonymous survey, available in English and Spanish, helps us improve the care experience for Colorado Access members and providers like you.
What Providers Need to Know:
If members ask about the survey, encourage them to complete it and explain how their feedback makes a difference in improving care. Thank you for helping us drive positive change!
To read past Health First Colorado and CHP+ CAHPS Reports, click here.
To learn more about the CAHPS, click here. |
Colorado Certified Community Behavioral Health Center (CCBHC) Updates
The State of Colorado intends to apply for participation in the 4-year Section 223 Medicaid CCBHC Demonstration program authorized by the Protecting Access to Medicare Act (PAMA) of 2014. This initiative aligns with Colorado’s broader goal to expand access to high-quality, comprehensive behavioral health services statewide.
This demonstration requires that at least two participating provider organizations be provisionally certified as Colorado Certified Community Behavioral Health Centers (CCBHCs) under federal and state standards, with at least one organization serving rural communities.
Colorado has selected four organizations to participate in the initial provisional certification cohort under the state’s proposed demonstration:
Additional provider organizations will have the opportunity to pursue CCBHC certification in each subsequent year of the demonstration, subject to federal approval and state capacity.
Final state participants in demonstration program will be formally announced by SAMHSA in June 2026. Full CCBHC certification of any Colorado behavioral health provider is contingent upon the state’s acceptance into the demonstration program.
To learn more about Colorado’s participation in the CCBHC Planning Grant, visit the CCBHC Planning Grant webpage. |
Eligibility Update: Lawfully Present Immigrants
Some lawfully present immigrants who currently qualify for full-benefit Health First Colorado and Child Health Plan Plus will lose eligibility beginning October 1, 2026, due to H.R. 1. This applies only to non-pregnant adults.
These immigrants will still qualify for Health First Colorado and CHP+:
We encourage affected members and their providers to plan for needed services before October 1 and not to delay care. |
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