COLORADO MEDICAL ASSISTANCE PROGRAM COLORADO MEDICAID EDI CONTRACT INSTRUCTIONS (SKCO0)

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1 COLORADO MEDICAL ASSISTANCE PROGRAM COLORADO MEDICAID EDI CONTRACT INSTRUCTIONS (SKCO0) Enrollment Instructions: Make sure you add your new TPID ( ) in Step 4 and select the appropriate boxes in Step 5. To check a box: right-click on the box you want to check select properties change default value to checked (or just delete the ones you don t need). Delete these instructions prior to sending to the providers you submit for. IMPORTANT: Complete one Payer Request Form (Page 5) per Tax ID. Return this request form to ABILITY Network Enrollment with your EDI documentation. All information is required unless you are not using a billing service ABILITY Network is not a billing service. Note: Some payers require additional enrollment forms- please review our payer list for additional requirements. Dear Provider, On March 1, 2017 the Department of Health Care Policy and Financing will launch a new claims payment system, known as the Colorado interchange. As part of this transition, we have enrolled with the new system, and have a new Trading Partner ID. On or after February 6, Please follow the instructions below to log into your web portal account and authorize us as your trading partner. We cannot submit your Health First Colorado (Colorado s Medicaid program) or Child Health Plan Plus (CHP+) claims or pick up reports on your behalf, until after you have completed this process. Please note that these instructions are only for providers who are approved in the Colorado interchange. If you are in the process of approval, please save these instructions for use when you are approved. If you have not started the process to revalidate or enroll with Health First Colorado, please visit Colorado.gov/HCPF/Provider-Enrollment.

2 Step 1: Login to the Provider Web Portal at Registration instructions will be sent to providers on February 6, o These instructions will be delivered via , from HPE. Step 2: Click Manage Accounts on the left-hand side of the page Step 3: Click the Link registered Trading Partner ID for X12 Reports tab

3 Step 4: Enter _ in the Trading Partner ID box and press Validate Trading Partner Step 5: Please select the following functions* and transactions and press Submit :: *Provider is solely responsible for the access they grant to Delegates, Billing Agents, Clearinghouses, or switch Vendors. Access can be changed at any time, but providers should be careful only to grant the minimum access necessary. Functions Alerts Care Management - Submit Resubmit Authorization Care Management - View Authorization Claim - Inquiry Claim - Submit and Resubmit Claim - Submit Pharmacy Enrollment Member Focus Viewing Payment History - Inquiry Provider Maintenance Secure Correspondence Verify Eligibility

4 Transactions Batch - X12 - Health Care Claim Payment/Advice D - Batch - X12 - Health Care Claim: Dental I - Batch - X12 - Health Care Claim: Institutional P - Batch - X12 - Health Care Claim: Professional

5 Payer Request Form (General Payers) Submit the completed Payer Request Form to: ABILITY Network, ATTN: Enrollment FAX: INSTRUCTIONS Complete one form per TAX ID. Return this form with your EDI documentation. All information is required unless you are NOT using a billing service ABILITY Network is not a billing service. Note: Some payers require additional enrollment forms please review our payer list for additional requirements. If you use a third-party billing service to prepare your claims, complete the top section of this form (if not skip to the provider information section). If you wish to receive ERA from any additional payers, add them in the space provided. BILLING INFORMATION Please type your responses directly into the form. Plaese check: New Request Change Request Billing Service Name TIN or ABILITY ID: Contact Name: Phone: ( ) Fax: ( ) Group/Provider Name: Please check for designation: Professional Institutional Billing Tax ID: Indicate TIN/EIN SSN Billing NPI: Street Address: City: State: Zip: Name of Authorized Signee: Title of Authorized Signee: PROVIDER INFORMATION List carriers/providers with which you wish to enroll below. Please refer to the ABILITY Network Payer List for enrollment requirements. Payer ID Payer Name PTAN Individual Provider Name Rendering NPI Claims ERA Questions or need assistance? Contact ABILITY Network Enrollment Department at or setup@abilitynetwork.com.