CO · guidance
CO HCPF Managed Care Programs Billing Manual — Community Behavioral Health Services Program
CommunityBehavioralHealthServicesProgram
Withtheexceptionofsomeselectpopulations/individuals,essentiallyallHealthFirstColoradomembersareautomaticallyenrolledintheCommunityBehavioralHealthProgram.ExceptionscanfoundintheCodeofColoradoRegulations(10CCR2505-108.212).
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TheBHOsareresponsibleforthecostofthebehavioralhealthserviceslistedinthemostrecentlyupdatedStateBehavioralHealthServicesBillingManual,forthebehavioralhealthdiagnoseslistedinAppendixTundertheAppendicesdrop-downsectionontheBillingManualswebpage.
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Thisincludesemergencydepartmentevaluationandmanagementcodes99281-99285.
AllproviderswhorenderemergencysubstanceusedisorderservicesonaUB-04mustbillFFStotheDepartmentofHealthCarePolicy&Financing's(theDepartment)fiscalagent.
AllprovidersmustcomplywiththeBHOsbillingpoliciesandprocedures.
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FullBenefitMedicare-HealthFirstColoradoEnrolleesmayobtainMedicare-coveredservicesfromeitherBHOornon-BHOproviders.ThefiscalagentacceptsandprocessessubmittedMedicarecrossoverclaims.
IfthebehavioralhealthserviceiscoveredbyHealthFirstColoradoonly,theFullBenefitMedicare-HealthFirstColoradoEnrolleemustobtaintheservicefromtheBHO.
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Behavioralhealth-relatedprescriptiondrugs.ClaimsforprescriptiondrugsaresubmittedtotheDepartment'sfiscalagentundertheFee-For-ServiceReimbursementProgramortotheMCOforMCO-enrolledmembers.
Nursingfacilityresidentialcare.NursingfacilityclaimsaresubmittedtotheDepartment'sfiscalagentforFFSreimbursement.
ServicesinaResidentialTreatmentCenter(RTC).RTCclaimsaresubmittedtotheDepartment'sfiscalagentforFFSreimbursement.
ClaimssubmittedtotheDepartment'sfiscalagentGainwellTechnologiesshouldbeaddressedto:
GainwellTechnologiesClaimsSubmissionP.O.Box30Denver,CO80201
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
df5811b686fcc0ed5d50ead1cffb17356836af415a2c2f904cf16b645f86c667
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