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FEBRUARY 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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Behavioral and Physical Health |
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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:
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Health First Colorado (TXIX), including Cover All Coloradans
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Emergency Medicaid Services (EMS), also called the “Emergency Medical and Reproductive Health Care Program”
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Child Health Plan Plus (CHP+)
Approved abortion codes listed below will be reimbursed with state-only funds for members enrolled in the above programs, regardless of circumstance. Members will not be subject to member 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, you must submit your claims to your CHP+ Managed Care Organization (MCO) 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 will be 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:
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O00.0-O00.9, Ectopic Pregnancy
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O01.0-O01.9, Hydatidiform mole
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O02.0-O02.9, Other abnormal products of conception
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O02.1, Missed Abortion (incomplete miscarriage)
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O03.0-O03.9, Spontaneous Abortion
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O08.0-O08.9, Complications following ectopic and molar pregnancy
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
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Surgical Procedure Codes: 10A07Z6, 10A07ZZ, 10A07ZW, 10A00ZZ, 10A07ZX, 10A08ZZ,
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The Obstetrical Care Billing Manual will reflect these changes on January 1, 2026.
Questions?
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Health First Colorado Behavioral Health Rendering
Provider Oversight (RPO) Policy
The final version of the RPO policy is now on the Behavioral Health Policies, Standards and Billing References webpage. Responses to frequently asked questions about the RPO policy will be posted soon. All Health First Colorado providers who are subject to this policy must submit this RPO attestation annually by January 1 to any Regional Accountable Entity (RAE) you are contracted with, to confirm your adherence to rules and standards outlined in the policy.
If you employ peer support professionals, you should sign and submit this attestation to your RAE(s) by January 1 (or ASAP), indicating that all peer support professionals delivering behavioral health services to Medicaid members are either certified or are in the process of becoming certified.
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New Transitions of Care Codes
As of January 1, 2026, transition of care (TOC) codes 99495 and 99496 are open. If you are an outpatient provider, you can bill the TOC codes for follow-up visits within 14 days of discharge from inpatient or observation-level care. TOC services play a critical role in reducing preventable readmissions and improving continuity of care for members following hospital or facility discharge. Learn more at the ACC Resource Center and January 2026 Provider Bulletin (page 24).
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Reminder: Claims Submission Compliance
Information on your claims MUST match the information in the Medicaid Management Information System (MMIS), including your NPI Provider Type and Taxonomy Codes. RAEs and MCOs will begin rejecting or denying claims on a rolling basis for providers who:
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Have used incorrect information during enrollment in the Medicaid Managed Information System (MMIS)
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Submit claims with information that does not match your National Provider Identifier (NPI) Provider Type and/or Taxonomy Codes in MMIS
Be sure your information is correct in MMIS. You may resubmit claims to your RAE/MCO with information that matches MMIS. See the fact sheet on Ensuring Compliant Managed Care Claim Submissions for more information. For questions or help making changes to your claims, contact our Provider Network Services team at ProviderNetworkServices@coaccess.com. |
Prenatal Plus Billing Manual Update
The Prenatal Plus Program Billing Manual has been updated to include new telemedicine guidelines and visit definitions. Contact HCPF_MaternalChildHealth@state.co.us with questions or concerns about the program. |
Lactation Support Services
The following provider types may provide lactation support services if it is within their scope of practice and they meet requirements of the International Board Certified Lactation Consultant (IBCLC), Certified Lactation Counselors (CLCs) or Certified Lactation Educators (CLEs): Certified Registered Nurse Anesthetists (PT 40), Occupational Therapists (PT 28) and Speech Therapists (PT 27). These provider types may provide lactation support services without a separate Provider Type 70 (Lactation Consultant) or 71 (Lactation Counselor or Educator) enrollment. Refer to the Lactation Support Services Billing Manual for more information.
Contact hcpf_maternalchildhealth@state.co.us with questions. |
Colorado Department of Public Health & Environment (CDPHE) Immunization Guidelines
The Colorado Department of Public Health & Environment (CDPHE) released a statement reaffirming their commitment to evidence-based vaccination guidance and continued access to preventive care. CDPHE recommends that families and providers follow the AAP’s 2025 Recommended Child and Adolescent Immunization Schedule. |
City of Aurora: New Microtransit Services for Adults 60+
Residents ages 60 and older in Aurora now have access to Aurora Rides, a free, on-demand microtransit service within a limited service area and hours. The city contracted with Via, in partnership with the Regional Transportation District, for this grant-funded pilot program. The program provides older adults with transportation to local essential services or a way to connect to the greater metropolitan transit system. |
News From HCPF |
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Prescriber Tool and Prescriber Alternative Payment Model: Webinar Recording Available
A recorded overview of the Prescriber Tool and Prescriber Tool Alternative Payment Model (APM) Year 3 is now available.
The Prescriber Tool is a powerful resource available directly within many EHR system workflows, giving providers seamless access to member pharmacy benefit information. This tool has integrated features such as e-prescribing, Real-Time Benefits Inquiry (RTBI) and electronic prior authorizations. Providers can make faster, more informed decisions with instant access to medication coverage details and lower-cost therapeutic alternatives—improving care while managing rising pharmaceutical costs.
The Prescriber Tool APM Year 3 started in October 2025. The APM incentivizes use of the Prescriber Tool and promotes pharmacy benefit compliance and cost efficiency. The Prescriber Tool APM shares a portion of the pharmacy program savings generated, if any, from prescriber use of the Prescriber Tool and preferred drug list compliance rates among participating practices.
For more information, see the Prescriber Tool Project and Prescriber Tool APM. |
Policy Statement on Care Coordination for Youth in Residential Behavioral Health Programs
A Policy Statement on Enhancing Regional Accountable Entity Care Coordination for Members Admitted to a Psychiatric Residential Treatment Facility, Qualified Residential Treatment Program, or Out-of-State High Intensity Residential Treatment identifies expectations for RAEs to provide care coordination and engage with members under age 21 admitted to residential behavioral health treatment facilities. These expectations ensure that appropriate and timely care is supported by the member’s care team and improve access to the full spectrum of Medicaid-covered behavioral health treatment services during and after residential treatment (e.g., Colorado System of Care identification and referrals). The policy became effective December 8, 2025. |
Long-Term Services & Support Program
In response to a significant and immediate statewide budget deficit, the Department of Health Care Policy & Financing’s Office of Community Living (OCL) is implementing a set of Long-Term Services and Supports (LTSS) Sustainability Actions to generate savings while positioning the program for long-term fiscal stability.
Read more here. |
Webinar on H.R. 1
Mark your calendar! The Department of Health Care Policy & Financing is offering a webinar to share Medicaid-related updates on H.R. 1.
H.R. 1 Medicaid Coverage, Eligibility and Implementation Updates Webinar | Register
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When: Tuesday, Feb. 24, 2026, from 9 to 11 a.m.
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About: During this webinar, HCPF will share Medicaid-related updates from the most recent Centers for Medicare and Medicaid Services (CMS) guidance, the implementation timeline of H.R. 1 for key changes such as semi-annual renewals and community engagement/work requirements, and opportunities for stakeholders to engage with us in the process. The webinar will also address the top concerns we heard from more than 700 respondents to our H.R.1 survey.
For more information: Visit the H.R. 1 impacts webpage. |
Oxygen Prior Authorization
Effective for claims received on or after March 1, 2026, providers who are providing 6 or more liters per minute (LPM) of oxygen to a member must obtain prior authorization prior to billing the HCPCS codes S8120 and S8121. Questionnaire 16, which can be found on the Provider Forms web page, must be completed and submitted with the PAR. Refer to the Durable Medical Equipment HCPCS Codes web page for more information.
Contact Alaina Kelley at Alaina.Kelley@state.co.us with questions. |
Updated Limitations and Documentation Requirements for Drug Testing
Adult members are limited to 16 combined units of service for definitive drug testing HCPCS codes G0480, G0481, G0482 and G0483 during the period from October 10, 2025, through June 30, 2026, based on date of service. Further information can be found in the Laboratory Services Billing Manual.
Contact Sarah Kaslow at Sarah.Kaslow@state.co.us with any questions. |
HCPF Statement on Medicaid Data Shared with CMS
Colorado is part of a multistate lawsuit seeking to prevent the Department of Health and Human Services (HHS) from sharing data with the Department of Homeland Security (DHS). While that case is ongoing, in a preliminary order, a federal judge indicated that HHS and the Centers for Medicare & Medicaid Services (CMS) may share certain data with DHS about individuals who are not lawfully residing in the U.S. To date, CMS has not provided Colorado guidance on whether or how this specific information might be shared.
Read more here.
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Upcoming Trainings
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ECHO Colorado Diagnosing Autism in Primary Care
This ECHO series supports primary care providers in identifying and addressing the health care needs of autistic youth and children with developmental challenges. Participants will enhance their skills in developmental screening and autism diagnosis for straightforward cases through a blend of expert-led presentations and engaging case consultations. The series aims to enhance the capacity of primary care providers, especially in underserved communities, to deliver timely, effective, confident care for autistic youth. Subject matter experts from Children's Hospital Colorado serve as presenters during these ECHO sessions.
This series is for primary care providers.
Commitment
Six weekly ECHO sessions held virtually
Wednesdays 12:00 p.m. - 1:00 p.m.
February 25 - April 1
Sign up for ECHO Diagnosing Autism in Primary Care. |
ECHO Colorado Newcomer Health Community of Practice Sessions
Recent immigrants to Colorado face significant challenges when accessing health care, including navigating complex systems, understanding shifting policy landscapes, and overcoming cultural and linguistic barriers. These challenges often result in care fragmentation, reduced access and poor health outcomes. This series is designed to equip health care providers and care coordinators with practical knowledge and strategies to address these gaps through policy awareness, system navigation, culturally responsive communication and attention to social determinants of health. This series features peer-to-peer discussions and expert presentations focused on the newcomer care landscape in Colorado. By the end of the series, attendees will be better prepared to provide comprehensive, equitable care to Colorado's newcomers.
This series is for medical providers, care coordinators, mental health and public health professionals who work closely with newcomers in Colorado.
Commitment
Three monthly ECHO sessions held virtually
Tuesdays 12:00 p.m. - 1:00 p.m.
March 17, April 14, May 12
Sign up for the ECHO Colorado Newcomer Health Community of Practice. |
News from Colorado Access |
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Update to Electronic Provider Add Forms
You must now be validated with the State of Colorado before submitting an add request. What’s changing:
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Attestation required: Submitters must confirm you have been validated with the State of Colorado when completing the add form.
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Form submission restriction: If attestation is not provided, the form cannot be submitted.
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Validation documentation: If a submitter attests to validation, but the State report does not confirm it, documentation will be required before you can be added to our systems.
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In cases where the State report does not confirm validation, submitters will have five business days to provide documentation.
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If documentation is not received within five business days, the request will be canceled.
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Higher Reimbursements for Outpatient Behavioral Health Services Provided in Other Languages
Did you know you can earn enhanced reimbursements for providing behavioral health services in languages other than English? Eligible outpatient providers can bill a 10% increased rate on direct outpatient behavioral health services offered in a member's identified language. Federally qualified health centers, community mental health centers, inpatient hospitals, and residential or bed-based services do not qualify for this incentive.
This program is exclusive to Colorado Access and applies only to contracted outpatient behavioral health service providers. It does not include services delivered with an interpreter. Talk to your provider network manager to learn more. |
Third-Party Billing and Trading Partner Agreement Requirements
If your practice uses a third-party billing company or other vendors to handle claims, remittances, or member information, we require written authorization and a trading partner agreement (TPA) to ensure the billing company can access necessary information while keeping your practice HIPAA-compliant.
A third-party billing authorization is your written consent that allows us to share provider and patient information with a third-party vendor for billing. We require written authorization by any provider whose information will be accessed by a third-party to document your consent to allow us to share your provider and patient information.
Every third-party billing vendor must have a completed TPA on file with us. You need to complete only one per company/vendor (not per provider). A TPA is a formal agreement and is valid only after we countersign it. This document must be issued by our compliance team. You can request it by emailing compliance@coaccess.com.
You must submit a written authorization email or letter to compliance@coaccess.com to authorize the third-party billing company/vendor access to both their member information on the provider’s behalf and provider information. Make sure to include:
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Provider name
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Name of the third-party billing company/vendor
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Confirmation of the relationship between the provider and the third-party billing company/vendor
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Description of the billing information that may be shared
Authorization remains valid until it’s revoked by the provider, or the provider and third-party billing company/vendor relationship ends. If your billing arrangement changes, notify us immediately in writing at compliance@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 provide 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 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. 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. Send requests to credentialing@coaccess.com. An approval/effective date will be provided, or you will be notified of the missing information needed to complete the primary source verification process. |
2026 CAHPS Survey: Help Us Hear from Your Patients
Starting mid-December, 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.
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Survey Timeline: Outreach runs from late winter/early spring.
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Completion Options: Members can respond online, by phone, or by mail.
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Statewide Focus: Increasing response rates is a key priority this year.
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!
Learn more about the CAHPS, |
Claims Auditing Vendor EXL
You may receive correspondence from EXL, our external claims auditing vendor. EXL reviews medical records for correct coding on our behalf. If you receive a request for information from EXL about a claim filed with us, please respond. |
Celebrate Black Mental Health and Wellness on February 28
Join us for the Celebration of Black Mental Health and Wellness on:
Wednesday, February 28, from 10 a.m. to 2 p.m.
1635 Paris Street
Aurora, CO 80010
Celebrate Black History Month with engaging wellness activities, inspiring speakers, and community connections. Hear from Dr. Aisha Rousseau, BHA Chief Strategy Officer, and John Priddy, Colorado Access VP of Health Plan Operations, and discover resources to support mental health and wellbeing.
Don’t miss this chance to learn, connect, and celebrate wellness in the Black community! |
Proposal for Contingency Management for Substance Use Disorder (SUD) Member Incentives
As Colorado Access enters the new ACC Phase III contract with HCPF, it must implement a cost-effective member incentives program that aligns with evidence-based best practices and addresses a priority area identified by the department. One of HCPF’s priority areas is the implementation of Contingency Management for substance use disorder (SUD).
Read more here. |
Colorado Access Address Change
As of January 5, 2026, we have moved to a new physical address/office:
Colorado Access
Access Management Services
4643 South Ulster Street
Suite 700
Denver, CO 80237
The address for mailing claims or for provider carrier disputes (claim appeals) will not change, but it is preferred to submit claims electronically via a clearinghouse and provider carrier disputes in the Colorado Access provider portal.
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