Colorado Medicaid and CHP+ provider revalidation and enrollment begins Sept. 15, 2015

Tuesday, June 30, 2015 01:59 PM

New federal regulations established by the Centers for Medicare and Medicaid Services require enhanced screening and revalidation of all Medicare, Medicaid, and CHP+ providers.

Beginning Sept. 15, 2015, all Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, will be required to enroll and revalidate their licensure and business information under new federal enrollment screening criteria. The Department of Health Care Policy and Financing (HCPF) has posted more information on the provider screening rule on their website; click on the Federal Provider Screening Regulations link.

Based on the federal CMS’s provider type and risk designation, this process may include a criminal background check, fingerprinting, and unannounced site visits – including pre-enrollment site visits for some providers. Providers who fail to revalidate and enroll by March 31, 2016 may have their claims suspended or denied.

Timeline
Existing Colorado Medicaid and CHP+ providers will begin revalidation/enrollment on Sept. 15, 2015. To help all existing providers meet the March 31, 2016 deadline, HCPF will group counties together and initiate a series of revalidation/enrollment ‘waves’ by county. A map showing the county waves/groups and a schedule of when each wave can begin their revalidation/enrollment will be released in July.

Providers are strongly encouraged to start preparing now by gathering documentation that will be needed to begin the revalidation/enrollment process:

• Obtain your National Provider Identifier (NPI).
  • If you do not have an NPI, you may request one through the National Plan and Provider Enumeration System (NPPES) website.
• Make electronic copies of certifications and licensures.

HCPF has created a general ‘Provider Enrollment Checklist’ that lists information you will need to have ready. The checklist and a number of helpful FAQs can be found on the Provider Resources webpage. Providers are encouraged to visit the website often as this information is updated frequently.