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CO HCPF Non-Emergent Medical Transportation (NEMT) Billing Manual — Provider Responsibilities
ProviderResponsibilities
LocalNEMTprovidersoutsideofthenine(9)countybrokerserviceareawillberesponsibleforthefollowing:
VerifyingmemberandmedicalprovidereligibilityforalltriprequeststhroughBatch270,theProviderServicesCallCenterIntegratedVoiceResponse(IVR)systemortheProviderWebPortal
Verifyingandretainingdocumentationforalltriprequestsincludingbutnotlimitedto:allrequiredstandardformslistedinthisbillingmanual
LocaltransportationprovidersoutsidethebrokerserviceareaareresponsibleforsubmittingtheirownclaimsthroughtheProviderWebPortal.Claimsshouldincludetherequiredinformationforeachtripandcorrespondingdocumentation,asreferencedinthisbillingmanual.
RefertoHCPFOM-074forcontextualinformation.
RequiredMemberEligibilityVerificationProcedures
EffectiveJune1,2025,OperationalMemoOM25-028hasbeenpublishedtoinstructNEMTprovidersoftherequiredproceduresforverifyingmemberbenefiteligibilityanddocumentingtransportationrequests.FollowingtheproceduresofthismemoismandatoryforallNEMTprovidersoutsideofthecurrentbrokernetwork(e.g.,providerswhodonotreceivetripassignmentsfromthebrokerandwhosubmitclaimsdirectlytotheDepartment).
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
8d377ff88c6425cc48809af879eefb9d9988a2e1cfde19199d4b718cd6f01a75
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