CO · guidance
CO HCPF Private Duty Nursing Billing Manual — Billing Information
BillingInformation
RefertotheGeneralProviderInformationManuallocatedontheBillingManualswebpageundertheGeneralProviderInformationdrop-downmenuforgeneralbillinginformation.
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EffectiveJuly1,2022,theDepartmentbeganenforcingthefederalrequirement42CFR§455.440,whichrequiresthatallclaimsforHomeHealthservicesincludetheNationalProviderIdentifier(NPI)oftheproviderwhoorderedtheserviceand42CFR455.440,thatrequirestheNPIisassociatedwithanactivelyenrolledwithHealthFirstColoradoProvider.ProvidersarerequiredtoentertheNPIoftheorderingproviderintothefollowinglocationsforclaimsubmission.IntheProviderWebPortal,thisfieldmaybelabeled"ReferringProvider".
Institutionalclaims
TheAttendingProviderfield(#76)ortheOtherIDfields(#78or#79)forbothpaperandelectronicclaims
ProvidersshouldrefertotheirapplicableUB-04billingmanualsforguidanceonhoweachfieldisused.
PrivateDutyNursingservicescanbeorderedbyeitheraphysicianoranallowedpractitioner.AllowedpractitionersaredefinedinaccordancewithStatelawasphysicianassistant(PA),nursepractitioner(NP),orclinicalnursespecialist(CNS).Theorderingprovidermustalsobeactivelyenrolled[HealthFirstColorado.Iftheseconditionsarenotmet,theclaimwillbedenied.
VisittheOPRClaimIdentifierProjectwebpageorrefertoProgramRule10CCR2505-108.125.8.Aforfurtherinformation.
Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
98c22d06b7ff32feb5f5f7fa7cc8ce492468f315ec8dc469c43a1556a68cbb50
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