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CO HCPF Qualified Residential Treatment Program Billing Manual — General Policies
GeneralPolicies
HealthFirstColorado(Colorado'sMedicaidprogram)membershavetheirbehavioralhealthservicespaidforbyRegionalAccountableEntities(RAEs).RegionalAccountableentitiesaremanagedcareentitiesresponsibleforcoveringbehavioralhealthbenefitsfornearlyallHealthFirstColoradomembers.
ResidentialservicesforchildrenoryouthinthecustodyoftheColoradoDepartmentofHumanServices-DivisionofChildWelfareorDivisionofYouthServicesareamongthemembersexemptedfromRAEcoveragebyProgramRule8.212.
VisittheHealthFirstColoradoRegionalOrganizationswebpagefordetailsaboutRAEcoverage.
ToverifyifaHealthFirstColoradomember'sbehavioralhealthservicesarecoveredbyanRAE,providersmustperformamembereligibilityqueryintheProviderWebPortal.EachRAEmayhaveitsownsimilartoolforproviderstoquerymembereligibility.Bothtoolsarevalidforcheckingmembereligibility.ThemembereligibilityquerywilldisplaywhethertheRAEisresponsibleforcoveringthemember'sservices.IfthememberiscoveredbytheRAE,allclaimsforcoveredbehavioralhealthservicesmustbesenttotheRAEforpayment.
AllbehavioralhealthprovidersmustbeenrolledwithHealthFirstColoradoandcontractedwiththeRAE.ProvidersmustcontacttheRAEwhichservestheirregiontobegintheenrollmentprocess.VisittheHealthFirstColoradoRegionalOrganizationswebpagefordetails.
ProviderswhoaredeniedRAEenrollmentmaynotbillGainwellFee-For-Service(FFS)asanalternativereimbursementroute.ProvidersdeniedRAEenrollmentmaynottreatHealthFirstColoradomembersforservicescoveredbytheRAE.
ProviderswhoaredeniedRAEenrollmentmaystillrenderandbereimbursedforservicesnotcoveredbytheRAE.
ProvidersmustreferencetheStateBehavioralHealthServicesBillingManualforalistofRAE-coveredservicesandconditions.
BillinginformationincludedbelowisonlyapplicabletoservicesrenderedtochildrenoryouthinthecustodyoftheColoradoDepartmentofHumanServices-DivisionofChildWelfareorDivisionofYouthServices,whoarenotcoveredbytheRAE.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
384f7257fea1e4c06a02cd622f778a4087cb0af9e25b84ae0f946402fe36e3fc
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