CO · guidance
CO HCPF Non-Emergent Medical Transportation (NEMT) Billing Manual — Prior Authorization
PriorAuthorization
AllNEMTrequestsmustbesenttotheStateDesignatedEntity(SDE)or,outsidethebrokerservicearea,anNEMTprovider.Themember,ormember'srepresentative,isresponsibleforobtainingpriorauthorizationandshouldberequestedassoonaspossible.TransportationprovidedwithoutauthorizationfromtheSDEorprovider,ortheirdesignee,willnotbereimbursedorpaid.ForinformationontheSDE'soraprovider’sauthorizationprocesses,contacttheSDEorproviderdirectly.
Whilenotrequiringpriorauthorization,mileageorbuspassreimbursementmaybedeniedifthememberdoesnotprovideproperdocumentationtotheStateDesignatedEntitywithintimelyfilingrequirements,orsoonerifrequiredbytheStateDesignatedEntity'spolicies.
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Train,airandout-of-statetravelmustbepriorauthorizedbytheDepartment.Membersand/ormedicalprofessionalsrequestingtrain,airorout-of-statetravelmustcontacttheirSDE.
NEMTcanonlybeusedtoaccessapprovedmedicalservices.10CCR2505-108.013requiresallmedicalservicestobeprovidedinColorado,unlesstheserviceisnotavailablein-state.
Transportationofthemember’sescortiscoveredforthereturntripoftheescortiftheywillnotbeaccompanyingthememberforacompleteroundtrip.Thisisapplicableforcircumstancesinwhichthememberisbeingplacedinfacility/residentialtreatmentandtheescortwillnotbestayingwiththem.
BillingInstructions:TheHealthFirstColoradoIDofthepersonbeingtransportedshouldalwaysbeusedforbilling.However,ifthepersonbeingtransportedisnotenrolledinHealthFirstColoradoordoesnothaveanactiveHealthFirstColoradoID,theHealthFirstColoradoIDofthechildforwhomthetransportationisofdirectbenefitshouldbeusedforbilling.Thisensuresthatthetransportationiscorrectlyattributedtothechild’smedicallynecessarycare.
TheSDEwillrequesttherequireddocumentationandsubmittotheDepartmentforreviewanddecision.ThedecisionwillbecommunicatedtotheSDE.
SDEsmustsubmitacompletedNEMTAir,Train,andOut-of-StateRequestFormasindicatedontheform.TheformislocatedontheNEMTwebpage.InadditiontotheNEMTOut-of-StaterequestformallOutofStaterequestsrequirethemostrecentclinicalnotesandaletterofmedicalnecessityfortreatmentand/orservicesoutsideofColorado.PleasesubmitthedocumentationtooutofstateNEMT@state.co.us.
Allrulesandpracticesforin-stateNEMTapplytotravelforroutinemedicalservicesprovidedtomembersinColoradobordercommunitiesperformedacrossthestatelineinaBorderTown/CityindicatedinAppendixFbecauseofcloserproximitytotheclosestqualifiedprovider.RefertoAppendixFlocatedontheBillingManualswebpageundertheAppendicesdrop-down.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
a59321a2644f5d5fb7efbb0c5aec92738060815585163a8e785209714013f33a
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