Colorado Medicaid and CHP+ Provider Revalidation & Enrollment Begins September 15, 2015
New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all Medicare, Medicaid, and CHP+ providers.
Beginning September 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 be validated and enrolled under new federal enrollment screening criteria. To meet these new requirements, as well as to ensure enrollment in the new claims processing system, Colorado providers must revalidate using the new Online Provider Enrollment (OPE) tool. Although the new OPE tool will launch in September 2015, Colorado Medicaid asks that provides complete your revalidation during your assigned revalidation and enrollment wave.
Based on the CMS provider type and risk designation, the revalidation process may include a criminal background check, fingerprinting, and unannounced site visits – including pre-enrollment site visits for some providers. Visit our provider resources page for information specific to your provider type and information specific to the Home and Community-Based Services (HCBS) provided (if applicable). Providers who fail to revalidate and enroll by March 31, 2016 may have their claims suspended or denied.
Revalidation & Enrollment Training Announcement
Enrollment Application Training Available
Online self-paced training for the new Colorado Online Provider Enrollment (OPE) tool is now available.
Who: All interested providers
When: Modules available online anytime beginning September 4, 2015
Where: Online via eLearning modules
Please visit the Provider Resources page to register!
CLICK TO ENLARGE
Medical Reval FAQ
Why am I required to go through the revalidation/screening process?
New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation for all existing (and newly enrolling). These regulations are designed to increase compliance and quality of care. The final regulations are being implemented at a federal level and were published in the federal register in February 2011.
What is the difference between revalidation and screening?
Revalidating is an enrollment process required every 5 years. Screening is verifying the provider is qualified for the risk level assigned.
Are non-medical service providers subject to revalidation/screening?
Yes, all providers who are enrolled with and bill Medicaid for services under the state plan or a waiver must be screened under this rule.
Will we be notified when we need to revalidate?
We are sending a revalidation notice letter to all currently enrolled providers. This letter will mailed 1-2 weeks prior to your enrollment wave, as a reminder.
I didn’t receive a Revalidation Notice letter, does this mean I don’t have to revalidate?
No, all providers need to revalidate regardless of whether you receive the Revalidation Notice letter. Please visit Colorado.gov/HCPF/Provider-Resources to see your assigned revalidation wave.
What is an enrollment wave window?
Your wave window is a suggested time frame in which we would like you to complete your revalidation. These waves are just recommendations; if you need to begin sooner or later you can. The most important date to remember is March 31, 2016. Providers not enrolled and revalidated by this date, may have their claims suspended or denied.
What should we do if our agency is spread out across multiple revalidation waves?
Go ahead and choose between the waves that you are assigned to, you do not need to notify us of this change.