MAY 2026

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. 

Benefits, Billing, and Code Updates 

Behavioral Health Benefit and Billing Updates

New Required Modifier for Services Delivered Under Oversight of a Rendering Provider – Effective July 1, 2026.

Effective July 1, 2026, billing providers must use Modifier U9 on all claims submitted for behavioral health services delivered by a pre-licensed or an unlicensed professional under a Rendering Provider.

The modifier signals that the service was provided by a clinician who cannot independently bill Medicaid and that the required oversight was in place.

For Colorado Access billing questions, contact claimsresearch@coaccess.com. For Medicaid policy questions, contact hcpf_bhbenefits@state.co.us.

Prior Authorization Requests for Health First Colorado Pediatric Behavioral Therapy

The Department of Health Care Policy & Financing (HCPF) has a new policy for pediatric behavioral therapy prior authorization requests (PARs). Beginning June 1, 2026, if a provider submits a PAR request with code 97151 for a member who already has an active PAR with another provider, the requesting provider must submit a Change of Provider form to prevent duplicative or overlapping PARs and claims. The Change of Provider form is on the HCPF’s Provider Forms web page in the PAR Forms section.

Contact HCPF_EPSDT@state.co.us with questions regarding this change. As a reminder, all pediatric behavioral therapy services must be billed fee-for-service directly to the state.

Health First Colorado Vaccination Billing

Health First Colorado (Colorado's Medicaid program) covers vaccine counseling visits in which health care providers talk to families about the importance of vaccination. Health First Colorado also covers and will reimburse for stand-alone vaccine counseling visits. Providers should not bill the vaccine counseling code and the vaccine administration code on the same date of service when vaccine administration codes include counseling.

Effective immediately, providers should bill CPT codes 90482, 90483, or 90484 for visits in which they offer counseling about the importance of vaccination. CPT codes G0310, G0311, G0312, G0313, G0314, and G0315 will no longer be reimbursed for dates of service after June 30, 2026.

Contact Christina Winship at Christina.Winship@state.co.us for vaccine policy questions. Contact the state’s Provider Services Call Center at 1-833-468-0362 for assistance with vaccine claims and billing.

Connect Pregnant Patients with a Doula

Health First Colorado covers doula services at no cost to eligible pregnant members. Doulas provide support during pregnancy, labor and birth, and the postpartum period. They help patients understand their choices and make informed decisions that align with their culture values and personal needs.

To help your patient find a Medicaid-enrolled doula, go to the Health First Colorado "Find a Doctor" search (healthfirstcolorado.com/find-doctors). Enter city or ZIP code. Under Provider Type, select Doula. You can also refer your patient for care coordination at Colorado Access, or ask them to call us at 866-833-5717.

Health First Colorado Electronic Data Integration (EDI) Vendor

Providers that use a clearinghouse or billing agent to submit X12 batch transactions to HCPF should notify their vendors that the State’s Electronic Data Integration (EDI) functionality, including batch processing and trading partner enrollment, is transitioning to Edifecs, a Cotiviti Business. Trading partners should keep their contact information current so they can sign the new agreement and receive login credentials.

See the May 2026 Health First Colorado Provider Bulletin for more information.

Health First Colorado Prior Authorization for Physician-Administered Drugs

Providers must have an approved authorization on file before administering any physician-administered drug (PAD) listed in Appendix Y.

Contact COProviderIssue@acentra.com with questions or for questions about registering for training.

Signature Requirement for Health First Colorado Outpatient Physical, Occupational, Speech Therapy and Audiology Service Care Plans

As of May 15, 2026, the initial plan of care (POC) for outpatient physical, occupational, and speech/audiology therapy for Health First Colorado members no longer requires a physician's signature when there is an existing physician order or referral, if the therapist maintains documentation demonstrating that the POC was delivered to the physician’s office within 30 days of completion of the initial evaluation. This change applies only to the initial Plan of Care. Recertification requirements, including physician signature requirements, remain unchanged.

Contact Devinne Parsons at Devinne.Parsons@state.co.us with questions.

Claims Tips 

Health First Colorado Claims Submitted to the State Will Deny for Expired Licenses

If you submit claims directly to Health First Colorado, you must verify the status of your license on file with Health First Colorado. Effective May 18, 2026, claims submitted directly to the state will deny if your license is expired. You must resubmit any previously denied claims once license updates are completed.

Not all licenses can be updated automatically in the system. Providers can update the license with a Provider Maintenance Request in the HCPF Provider Web Portal. See the Update Licenses and CLIA Quick Guide for instructions on adding or updating a license.

Long-Term Services and Supports Updates

Prior Authorization for Pediatric Long-Term Home Health Services

Effective May 4, 2026, PARs are required for all members receiving pediatric long-term home health (LTHH) services, including physical therapy (PT), occupational therapy (OT), speech therapy (ST), skilled nursing (RN/LPN) and certified nursing assistant (CNA) services. Beginning June 1, 2026, PAR compliance will be fully enforced.

Contact COProviderIssue@acentra.com for PAR submission assistance and training.

Training and Assistance 

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.  

Register for the Town Hall Meetings here.

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:   

• June 4, 2026, from 10:30 to 11:15 a.m.  

Please email hcpf_maternalchildhealth@state.co.us with any questions.  

ECHO Series: Supporting Patients at High Risk for Breast Cancer: Insights for Primary Care and OB/GYN

This six-session ECHO series will help primary care and OB/GYN providers assess risk, counsel patients, and partner with breast cancer specialists, all within the primary care setting. Participants will learn how to use eConsults to obtain timely specialty input, improve care coordination, and reduce unnecessary referrals and patient travel. Nurses and medical residents in primary care and OB/GYN offices are also welcome.

The series will be on Mondays from 12:00 to 1:00 pm, May 4 to June 15, 2026.

Sign up for the Supporting Patients at High Risk for Breast Cancer series.

ECHO Series: Managing Rheumatic Conditions in Primary Care

This six-session ECHO series will review the most common questions primary care providers have for rheumatologists. Sessions will delve into the key topics touched on by these questions, dissecting an efficient diagnostic process and outlining an initial treatment strategy. We will explore evidence-based therapies to help providers improve patient outcomes within the medical home, with providers practicing at the top of their scope.

The series will be on Tuesdays from 12:00 to 1:00 pm from May 5 to June 9, 2026.

Sign up for Managing Rheumatic Conditions in Primary Care.

News and Announcements 

Colorado System of Care: Forum for Potential

Colorado System of Care (CO-SOC) is looking to expand and grow the provider network for services to the most vulnerable children and youth. On Wednesday, June 17, 2026, 1:30 p.m. to 3:00 p.m. MT, HCPF will hold a forum on Zoom about CO-SOC. A national expert, Dr. Rick Shepler, will present on the Colorado Intensive Home-Based Treatment (CO-IHBT), a framework for delivering intensive mental health services to youth with serious emotional disabilities. HCPF will talk about the CO-SOC philosophy, the partnership with the Regional Accountability Entities (RAEs), and the opportunities for funds to support expansion through the Workforce Capacity Center at Colorado State University.

The forum is open to anyone. Agencies or providers who want to join the CO-SOC are especially encouraged to attend. No registration is needed. Join the June 17 forum.

Contact hcpf_co_soc@state.co.us with any questions.

Learn About HR1 Outreach and Share Your Feedback

Join Colorado Access and the Center to Advance Consumer Partnership (CACP) to learn about plans to keep members of Health First Colorado informed about changes coming to Medicaid due to HR1.

CACP is working closely with HCPF and partners like you to develop a unified HR1 communications plan and toolkit for all stakeholders, so members receive accessible, consistent, and timely information about federal changes to Medicaid.

To learn more and share your needs and concerns, register to join one of these Zoom conversations:

• Tuesday, June 2, 2026 at 8:00 a.m.: Register here.
  

• Thursday, June 4, 2026 at 12:00 p.m.: Register here.