Billing Manuals

Which billing manual should I use based on my provider type?

General Provider Information

• General Provider Information Manual (3/24)

Electronic Visit Verification Manual

• Electronic Visit Verification Manual

Managed Care Encounters Reporting Guide

• Managed Care Encounters Reporting Guide (3/23)

Appendices

• Appendix A - Colorado Department of Health Care Policy and Financing (8/23)
• Appendix B - Colorado Medical Assistance Program Fiscal Agent (6/22)
• Appendix C - Prior Authorization and Review Agencies (6/22)
• Appendix D - Programs/Services and Authorizing Agencies (6/22)
• Appendix E - County Departments of Human and Social Services (2/19)
• Appendix F - Border Towns (6/22)
• Appendix G - Outpatient Hospital Unbundled Durable Medical Equipment Codes (1/23)
• Appendix I - Provider Participation Agreement (6/22)
• Appendix M - Procedures Requiring Prior Authorization (4/19) Refer to the Health First Colorado Fee Schedule to see if a PAR is required for the procedure code.
• Appendix N - Prior Authorization Request Denial Reasons (5/17)
• Appendix O - EAPG Inpatient Only List (1/23)
• Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criteria (1/24)
• Appendix Q - Revenue Code Table (7/21)
• Appendix R - Remittance Advice (RA) Messages (4/24)
• Appendix S - Remittance Advice (RA) Expenditure Reason Codes (12/18)
• Appendix T - Capitated Behavioral Health Program - Refer to Appendix C of the State Behavioral Health Services Billing Manual located on the Accountable Care Collaborative Phase II - Provider and Stakeholder Resource Center web page under Behavioral Health Services.
• Appendix U - Forms - No longer active. Visit the Provider Forms web page.
• Appendix V - Terms, Acronyms and Abbreviations (6/18)
• Appendix W - No longer active.
• Appendix X - HCPCS/NDC Crosswalk for Billing Physician-Administered Drugs (4/24)
• Appendix Y - Physician-Administered Drug Medical Benefit Prior Authorization Procedures and Criteria (1/24) (Located under Fee for Service Physician Administered Drugs dropdown menu)
• Appendix Z - Hospital Specialty Drugs (4/24)

CMS 1500 (Professional)

• Ambulatory Surgery Centers (ASC) (5/23)
• Audiology (4/24)
• Behavioral Health Secure Transportation (BHST) (1/24)
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (4/24)
  • DMEPOS HCPCS Codes
  • Wheelchair Benefit Coverage Policy
• Early Intervention (12/22)
• Emergency Medicaid Services (1/24)
• Family Planning Benefit Expansion for Special Populations (8/23)
• Gender-Affirming Care (8/23)
• Immunization (1/24)
• Laboratory Services (8/23)
• Managed Care Programs (10/22)
• Medical-Surgical (10/23)
• Nurse Home Visitor Program (9/20)
• Obstetrical Care (9/23)
• Outpatient Behavioral Health Fee-for-Service (5/23)
• Outpatient Imaging and Radiology (3/24)
• Program of All-Inclusive Care for the Elderly (PACE) (4/21)
• Pediatric Behavioral Therapies (1/23)
• Pediatric Personal Care Benefit (9/23)
• Pharmacist Services (02/24)
• Physical and Occupational Therapy (4/24)
• Physician-Administered Drugs (PAD) (3/24)
• Prenatal Plus Program Outpatient - Fee-For-Service (5/23)
• Qualified Residential Treatment Program (12/23)
• Residential Child Care Facility (RCCF) Program (7/22)
• School Health Services (9/23)
• Screening, Brief Intervention and Referral to Treatment (SBIRT) Program (3/23)
• Speech Therapy (4/24)
• Targeted Case Management - Transition Coordination (02/22)
• Telemedicine (1/24)
• Transportation
  • Behavioral Health Secure Transportation (1/24)
  • Emergency Medical Transportation (EMT) (7/21)
  • Non-Emergent Medical Transportation (NEMT) (2/24)
• Vision Care and Eyewear (3/24)

Dental

DentaQuest Colorado Medicaid and CHP+ Dental Program Providers (10/22)
(The above link will redirect to the DentaQuest Colorado Providers web page.)

HCBS

• HCBS - Adult - Brain Injury (BI), Community Mental Health Supports (CMHS) and Elderly, Blind, and Disabled (EBD) (2/24)
• HCBS - Complementary and Integrative Health (CIH) (2/24)
• HCBS - Children's Home and Community Based Services (CHCBS) and Children with Life Limiting Illness (CLLI) (4/23)
• HCBS - Children's Habilitation Residential Program (CHRP) Waiver Program (2/24)
• HCBS - Persons with Intellectual and/or Developmental Disabilities Waiver Programs & Targeted Case Management for Home and Community-Based Services Waiver Programs (2/24)

Pharmacy

• Pharmacy (9/23)
• Pharmacist Services (02/24)
• 340B Policy and Procedures (11/23)

UB-04 (Institutional)

• Dialysis (1/24)
• Emergency Medicaid Services (1/24)
• Federally Qualified Health Center and Rural Health Center (8/22)
• Home Health (9/23)
• Hospice (12/23)
• Indian Health Services (12/23)
• Inpatient/Outpatient (IP/OP) (3/24)
• Nursing Facility (4/23)
• Private Duty Nursing (9/23)
• Psychiatric Residential Treatment Facilities (12/23)