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SEPTEMBER 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
Issued on August 31, 2026, Colorado HCPF Policy Transmittal 26-27-03 notifies Regional Accountable Entities that new daily unit limits (CO MUEs) and same-day reporting restrictions (PTP edits) will take effect on October 1, 2026, for select supportive and team-based behavioral health services under the Supportive Services Sustainability Strategy. While services billed over the daily limit will trigger automatic denials, providers may appeal with clinical documentation, and RAEs must enforce the edits and notify affected members.
Billing Manual
Appendix
Fee Schedules
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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 the Department of Health Care Policy and Financing (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 will lose Health First Colorado (Colorado's Medicaid program) coverage on October 1, 2026. This includes refugees and asylees, people granted humanitarian paroles, and others. For details, see Health First Colorado’s website about changes to eligibility due to H.R. 1.
We’re gathering feedback about H.R. 1 material needs. We'd love to hear from you about what you need to help communicate these changes. This simple form should only take a few minutes to complete.
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.
Information covered in these letters include:
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Licensure Requirement Reminder
Providers are reminded to verify the status of their license on file with Health First Colorado (Colorado’s Medicaid program). Claims with dates of service of August 1, 2026, or later will deny for Explanation of Benefits (EOB) 3385 – “Provider license not active on date of service” – if an updated license is not on file. Not all licenses can be updated automatically in the system. Providers can update their license in the Provider Web Portal by submitting a Provider Maintenance Request. Refer to the Update Licenses and Clinical Laboratory Improvement Amendments (CLIA) Quick Guide for instructions on adding or updating a license. Providers must resubmit any previously denied claims once license updates are completed.
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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, contact the Behavioral Health team at Behavioral.Health@coaccess.com. |
Identifying and Treating Obsessive-Compulsive Disorder in Children and Teens
A Patient-Centered Outcomes Research Institute (PCORI)-funded review examined evidence from more than 100 studies on diagnosing and treating obsessive-compulsive disorder (OCD) in children and teens. The review identified which treatment approaches may improve symptoms and help children and teens achieve remission, providing evidence that families and clinicians can use when considering treatment options.
Explore the Evidence Update to learn about the findings.
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Environmental Health and Primary Care: Supporting Patients Across Colorado
All Coloradans experience health hazards caused by environmental factors, particularly those in rural and frontier communities. Due to limited time and formal education in environmental health, Colorado clinicians often have gaps in their knowledge when it comes to these important topics.
In partnership with the Colorado Department of Public Health and Environment (CDPHE), this Extension for Community Health Outcomes (ECHO) series covers key environmental health topics, including heavy metals poisoning, emerging environmental contaminants, and indoor and outdoor air quality. Participants will also learn more about sources of exposure, who is at greater risk when exposed, and resources and tools for you and your patients.
AUDIENCE
Primary care providers (MD, DO, PA, NP, RN) and other patient-facing health care professionals in Colorado.
COMMITMENT
Four weekly ECHO sessions held virtually
Wednesdays 12:00 - 1:00 PM MT
October 7 - 28
Sign up here.
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Save the Date: H.R. 1 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: Wednesday, October 14
Time: 11:30 a.m. – 1:00 p.m.
Format: Virtual (recording and presentation materials will be shared afterward)
What We'll Cover
This session is designed to help practices better understand upcoming changes, prepare their teams, and connect members to available resources.
More information and registration details will be shared through existing provider and community communication channels, including Practice Support meetings, email updates, and the Provider Update.
We encourage all interested providers and community partners to mark their calendars and join us for this important discussion.
Registration opening soon! |
News and Announcements |
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Update to UM Coverage Hours-Effective October 25, 2026
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Effective October 25, 2026, Colorado Access Utilization Management will move 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 detail, 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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Feedback for the Colorado Timely Care Starts Here: Helping Members Get the Right Care at the Right Time on Medicaid
Timely access to care is essential to support better health outcomes and a positive membership. Colorado Access is committed to helping Health First Colorado and CHP+ members get the care they need when they need it. Updated Access to Care and Scheduling Standards reinforce this shared responsibility and help ensure members receive timely, appropriate support across our provider network.
Why This Matters
Access standards support network adequacy, reduce delays in treatment, improve care coordination, and strengthen member satisfaction. They also help Colorado Access meet contractual requirements while advancing our commitment to high-quality, person-centered care.
What Providers Need to Know
Providers play a key role in improving access by:
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Working Together to Strengthen Access
We understand that workforce shortages, staffing challenges, and capacity limitations can affect appointment availability. If your practice is unable to meet required timeframes, please document the circumstances, offer the next available appointment, and work with Colorado Access to identify solutions that support timely member care.
Together, we can reduce delays, improve access, and help members receive the high-quality care they deserve.
View the Access to Care flyer here.
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Feedback for the Colorado Commission on Medicaid
The Colorado Commission on Medicaid wants to hear from people who use, provide, pay for, or work in the Medicaid program. The Commission will deliver its final recommendations in December to implement a sustainable Medicaid program.
The survey is here.
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CHP+ Formulary Updates
The CHP+ Formulary changes on a monthly basis.
View the recent updates that went into effect this past month here.
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