Audiology

Providers must be enrolled as a Colorado Medical Assistance Program provider in order to: 

Treat a Colorado Medical Assistance Program member 

Submit claims for payment to the Colorado Medical Assistance Program

Billing Information

National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act (HIPAA) requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information electronically in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions.

Paper Claims 

Electronic claims format shall be required unless hard copy claims submittals are specifically prior authorized by the Department of Health Care Policy and Financing (the Department). Requests for paper claim submission may be sent to the fiscal agent, Xerox State Healthcare (Xerox), P.O. Box 30, Denver, CO 80201-0090. 

The following claims can be submitted on paper and processed for payment:

•  Claims from providers who consistently submit 5 claims or fewer per month (requires prior approval) 
• Claims that, by policy, require attachments 
• Reconsideration claims Paper claims do not require an NPI, but do require the Colorado Medical Assistance Program provider number. 

In addition, the UB-04 Certification document must be completed and attached to all claims submitted on the paper UB-04. Electronically mandated claims submitted on paper are processed, denied, and marked with the message “Electronic Filing Required”.

Electronic Claims

Instructions for completing and submitting electronic claims are available through the following: 

•  X12N Technical Report 3 (TR3) for the 837P, 837I, or 837D
•  Companion Guides for the 837P, 837I, or 837D in the Provider Services  section of the Department’s website.
• Web Portal User Guide (via within the Web Portal)