CO · guidance
CO HCPF General Provider Information Manual — Introduction to the Manual
IntroductiontotheManual
ThismanualprovidesgeneralinformationaboutHealthFirstColoradotoassistenrolledproviderswithsubmittingclaimsforservicesrenderedtoHealthFirstColoradomembers.
Providersandtheirstaffshouldfamiliarizethemselveswiththemanualandrefertoittoanswerprogramandbillingquestions.Usingtheinformationinmanualsandbulletinshelpseliminateprogramandbillingmisunderstandingsthatcanresultinpaymentdelays,incorrectpaymentsandpaymentdenials,regardingcoveredservices,membereligibilityandbillingprocedures.
Rules
ThemanualsareinstructionalguidesandarenotHealthFirstColoradopolicymanuals.
TherulesandregulationsgoverningHealthFirstColoradopolicymaybefoundinVolumeVIII,theMedicalAssistanceManualoftheColoradoDepartmentofHealthCarePolicyandFinancing(ProgramRulesandRegulations).TheserulesalsoareavailableintheColoradoCodeofRegulations(10CCR2505-10)availableatmostlibraries.
TheHealthFirstColoradoProviderBillingManualscontainbasicbillingandbenefitinformationaboutHealthFirstColorado.TheProviderBillingManualsaretheonlyauthorizedbillingproceduremanualsforHealthFirstColorado.Providersmaydownloadcopiesofmanualsasneeded.ThemanualsaredesignedtohelpproviderscorrectlyfileHealthFirstColoradoclaims.
ElectronicBilling
TheBillingManualsaredesignedtobeusedbybothelectronicandpaperclaimbillersasaHealthFirstColoradopolicyreference.Providersshouldfileelectronicclaimswheneverpossible.Forinstructionsonelectronicbilling,seebelow:
Batchbillersmayusetheexplanationsofthepaperclaimfieldslocatedinindividualmanualstoclarifyfielddescriptionsonelectronicclaims.BatchbillersshouldutilizeelectronicspecificationsintheTR3andintheappropriateCompanionGuides.
ElectronicbillersusingtheProviderWebPortalmayusetheQuickGuides.
TheHealthFirstColoradoProviderManualsconsistof:
ThismanualcontainsHealthFirstColoradoinformationcommontoallprovidertypes,includingeligibility,coveredservicesandproviderenrollmentandparticipationguidelines.
Thesedocumentsincludecontactaddressesandphonenumbers,priorauthorizationinformation,aglossary/acronymlistandadditionalreferenceinformation.
ThismanualcontainsHealthFirstColoradoinformationspecifictoprovidertypes,includingpaperclaimsandelectronicclaims.
ThisdocumentprovidesalinktothePharmacybillinginstructions.
Thisdocumentcontainsprogram-specificbenefit,proceduralandbillinginformationforprovidersbillingontheCMS1500paperclaimform.
Thesemanualscontainprovider-specificbenefit,proceduralandbillinginformationforprovidersbillingontheCMS1500paperclaimform.
Thesemanualscontainprogram-specificbenefit,proceduralandbillinginformationforHomeandCommunityBasedServicesandshouldbeusedwiththeBillingInformationsectionfordetailedCMS1500claimfieldcompletioninstructions.
Thesemanualscontainprovider-specificbenefit,proceduralandbillinginformationforprovidersbillingontheUB-04paperclaimform.
RefertotheDentaQuestOfficeReferenceManualforinformationondentalbilling.
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UpdatedHealthFirstColoradoinformationispublishedinProviderBulletinsandProviderNews.AlinktothemostrecentbulletinissenttotheservicelocationemailaddressonfilewiththeDepartment'sfiscalagent.UpdateyourcontactinformationintheProviderWebPortalasneededandsignuphereunderEmailList"00-AllProviderEmails"toensureyoureceivenotificationsforeachProviderBulletin.
KeepthecurrentHealthcareCommonProcedureCodingSystem(HCPCS)procedurecodebulletinforyourprogramwithyourprogram-specificmanual.Replaceprocedurecodebulletinsasnewbulletinsarepublished.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
925d8e1b641510331dfcd9c4cca175d2c1e29c860dccb1cb3a38f97ac7e931e6
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