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APRIL 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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Remote Patient Monitoring
Effective April 1, 2026, all outpatient remote patient monitoring services will require a qualifying diagnosis code for coverage. A qualifying ICD-10 code must appear within the first four diagnosis code positions on the claim. Remote patient monitoring is for members with diabetes, COPD, heart failure, asthma, pneumonia, or a high-risk pregnancy.
Coverage is subject to medical necessity and requires documentation supporting the qualifying diagnosis, as outlined in the Telemedicine and eConsult Billing Manual. Qualifying conditions and billing requirements align with guidance issued by the Department of Health Care Policy and Financing (HCPF) pursuant to Colorado Senate Bill 24‑168. Contact Sahara Karki at Sahara.Karki@state.co.us or Morgan Anderson at Morgan.Anderson@state.co.us with questions.
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Fee-for-Service Rate Reductions
Effective April 1, 2026, HCPF has reduced all applicable fee-for-service rates to 85% of their Medicare benchmark. This is to comply with the executive order issued by Governor Polis to address the state’s revenue shortfall. Fee schedules are located on the Provider Rates and Fee Schedules web page.
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Behavioral Health Service and Rate Changes
The following changes to our behavioral health contracts will be effective July 1, 2026:
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H0038 (self-help/peer services, 15 minutes), H2014 (skills training and development, 15 minutes), H2032 (activity therapy, 15 minutes): The rate for these supportive, nonclinical services will decrease to $7.71 for both Child Health Plan Plus (CHP+).
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Medically Monitored Inpatient Withdrawal Management (ASAM level 3.7-WM, REV code 1002 or HCPCS code H0011): All services at this ASAM level now require prior authorization.
We identified the need for these changes after a thorough and careful review of rates and utilization of services. We are grateful for the work our providers do every day to meet the needs of our members. These changes are not a reflection of how much we value your work.
We are committed to supporting providers and members through the transition. Our priority is to maintain access and continuity of services for our members, particularly those with the highest needs. Please contact Provider.Contracting@coaccess.com with questions.
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Access Stabilization Payment Program Suspended
HCPF had planned to implement Access Stabilization Payments this year, to support small, rural and pediatric primary care medical providers (PCMPs) that historically could not participate in value-based payments. Due to budget constraints caused by H.R. 1 (One Big Beautiful Bill Act) and other factors, the state legislature voted to suspend this program.
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Colorado Access Telehealth Policy
The Colorado Access telehealth policy addresses the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and health-related information across distance for Health First Colorado (Colorado's Medicaid program) and CHP+ members.
Telehealth services must be delivered synchronously (real-time interaction) and meet the same standard of care as services delivered in person. The availability of services through telehealth does not alter a provider’s scope of practice and does not authorize the delivery of health care services in a setting or manner not otherwise permitted under your contract with us or by law.
Services may be delivered by telephone (audio only) only when it is clinically appropriate, no other form of service delivery is possible, and the reason is documented in the member’s clinical record. When a service is provided via audio-only telephone, modifier FQ must be appended in the first available position on the claim.
Place of Service Codes
Members who are new to a provider must contact the provider to initiate telehealth services, and telehealth services for established members must be consistent with the member’s documented treatment plan. Providers must document the member’s consent, either verbal or written, to receive services via telehealth. Record keeping and member privacy standards must comply with HIPAA and 42 CFR Part 2 regulations. |
Claims Tips |
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Avoid These Common Claim Mistakes for Faster Payment
Avoid common mistakes on claims so your payment is not delayed:
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Use the billing name exactly as it is on your contract, and use the rendering provider name exactly as it is on state enrollment, including middle initials.
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Do not include credentials (e.g., LPC, PhD, LCSW, MA).
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Enter the correct NPI.
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Fill out all fields.
Help us to help you get paid! Questions? Contact customer.service@coaccess.com.
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Long-Term Services and Supports Updates |
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Community Connector Service
HCPF is updating the Community Connector service in both the Children's Extensive Supports (CES) and the Children's Habilitative Residential Program (CHRP) Waivers beginning April 1, 2026. This change will be implemented during the Continued Stay Review through March 2027. It is not retroactive.
Updates include a new rate, reduced services limits, and guidance that services must be authorized based on a child’s assessed exceptional or extraordinary community engagement needs.
See the Community Connector Fact Sheet and Operational Memo for more information.
For more information about this and other planned changes to make long term services and supports (LTSS) more sustainable, see the HCPF LTSS Updates page.
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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.
Register for the Town Hall Meetings here.
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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 from May 4 to June 15.
Sign up for the Supporting Patients at High Risk for Breast Cancer series.
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ECHO Series: Pediatric Suicide Prevention: A Practical Care Pathway for Primary Care
Join ECHO for a three-session ECHO series to support primary care providers in the outpatient setting with suicide prevention based on the Zero Suicide framework. Sessions cover the implementation of an evidence-based screening tool, assessment, safety planning, and ongoing support for 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.
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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.
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Screening, Brief Intervention and Referral to Treatment (SBIRT) Training for Health First Colorado Providers
Free Screening, Brief Intervention and Referral to Treatment (SBIRT) training for Health First Colorado providers is provided through partnership with Peer Assistance Services, Inc.
Face-to-face training and consultations are available through various entities such as SBIRT Colorado, Carina Health Network (formally Colorado Community Managed Care Network), and the Emergency Nurses Association.
Providers can also practice SBIRT and motivational interviewing skills with Peer Assistance Services’ new self-paced interactive practice scenarios. Create a free account to access simulations with guided prompts to walk through each interaction to build your skills.
Contact Janelle Gonzalez at Janelle.Gonzalez@state.co.us with questions.
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Opportunities to Give Feedback |
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Feedback Requested: Behavioral Health Peer Recovery Groups Policy
A draft policy on Behavioral Health Peer Recovery Groups has been created to provide clarity on the Peer Support services that are covered by Health First Colorado. This draft policy outlines standards for Peer Recovery Group activities and aligns with the Behavioral Health Administration (BHA) definitions outlining disallowed activities for Peers.
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News and Announcements
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Childhood Vaccine Recommendations
The federal government recently announced changes to the Centers for Disease Control and Prevention’s childhood vaccine recommendations. However, in Colorado, our recommendations have not changed.
Colorado follows the American Academy of Pediatrics schedule for childhood vaccine recommendations—the gold standard in pediatric care. In late 2025, the Colorado Board of Health officially incorporated the American Academy of Pediatrics vaccination schedules into our state requirements to attend school and childcare in Colorado.
Health First Colorado and CHP+ continue to cover all recommended childhood vaccines.
Please share vaccine information with your practice and patients using the Colorado Department of Public Health and Environment (CDPHE) Impact of federal childhood vaccine recommendation changes toolkit and Evidence-based vaccine messaging materials.
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Health First Colorado Website Redesigned
The Health First Colorado website has a brand-new look! The site is easier to navigate and includes new resources. Members can find information describing upcoming Medicaid changes and read the updated and reorganized frequently asked questions. They can also try the screening tool to help them understand whether they might be affected by work requirements (community engagement requirements). The state will continue to update the site, including expanded Spanish-language content.
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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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Bicillin L-A Shortage
The U.S. Food and Drug Administration (FDA) is allowing the temporary importation of Lentocilin© due to the ongoing limited availability and extended recovery of Bicillin® L-A. The National Network of STD Prevention Training Centers has posted information for health care providers on the administration of Lentocilin©.
Providers should prioritize using BPG to treat people with syphilis during pregnancy, as penicillin is the only recommended treatment for pregnant women and babies with congenital syphilis. Choose doxycycline others. Accurately stage syphilis cases to ensure appropriate use of antimicrobials. Early syphilis (primary, secondary, and early latent) only requires one dose of 2.4 million units of BPG, including during pregnancy.
Clinicians with questions about syphilis clinical management should contact an infectious diseases specialist or the online National Network of STD Clinical Prevention Training Centers (NNPTC) STD Clinical Consultation Network.
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Pharmacy Benefit Management System Change
HCPF Pharmacy Benefit Management System and Real-Time Benefit Tool Pharmacy modules went live on April 1, 2026.
A new vendor, MedImpact Healthcare Systems, Inc. will replace Prime Therapeutics (formerly Magellan). The PBMS system and contact information will be new, but the Bank Identification Number (BIN) and Processor Control Number (PCN) will remain the same, and pharmacies will submit their claims as usual. For more information and MedImpact’s contact information, see the February, March or April 2026 provider bulletins or reach out to the Provider Contact Center.
This change applies only to pharmacy claims billed to the state. The Colorado Access PBMS for CHP+, Navitus, is not changing.
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Eligibility Update: Lawfully Present Immigrants
Some lawfully present immigrants who currently qualify for full-benefit Health First Colorado and CHP+ 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. |
