Medicaid Resources

Click here to get started: Provider Enrollment
(hcpf.colorado.gov/provider-enrollment)

WATCH: How to Enroll and Tips for Success Roundtable

The entire Provider Enrollment Manual is very important to read.

• Before you begin enrolling, note the "Additional Required Information" linked in the manual's table of contents.
• Note the information regarding NPI:
  • Individual Within a Group: Both group and individual will need to have an NPI
  • Billing Individual (solo practitioner): Both individual and facility need to have an NPI
• Attachments Needed:
  • License
  • Board Certification (for ortho)
  • Malpractice Liability
• Additional Attachments Needed for Individuals:
  • W9 (signed and dated within last six months)
  • Voided check or bank letter
  • Affidavit of lawful presence

We have the opportunity to improve access to care for almost 25% of Colorado residents!

Provider Benefits

• No deductibles or co-pays
• Comprehensive child oral health coverage
• Rapid payment
• Continuity of patients, patient care and revenue
• Flexible patient panel sizes
• Administrative support
• Competitive provider reimbursement rates

• Medicaid “Health First Colorado” is a joint state and federally funded program providing healthcare coverage for low-income families, pregnant women, children and individuals with special healthcare needs.
  
  
• Key Players
  • Medicaid
  • HCPF (Department of Health Care Policy and Financing)
  • DentaQuest

The CDA Medicaid Committee lobbied on the behalf of CDA members to achieve a substantial rate increase in 2024 on 28 of the most meaningful and needed patient codes. 

• 15 preventative codes were increased to 100% of the 2020 ADA Survey of Fees
• 13 diagnostic and crown codes were increased to 70% of 2020 ADA Survey of Fees.
• An additional 2% rate increase was achieved across all codes

A full rate review for dental codes will occur in 2026. The Medicaid Committee will continue to work diligently to increase access-to-care by increasing provider participation.

• View the 28 codes, effective July 1, 2024
• View the full Medicaid fee schedule

Click here for a full list: Common Reasons Enrollment Applications are Returned

With special attention to these reasons:

• Missing or Non-Matching License or Certification Attachment
• Answer to Supplemental Question (located in “Other Information” section)
• National Plan and Provider Enumeration System (NPPES) Address
• Incorrect Taxonomy Code
• Medicare Number Not Verified (OS)
• DEA Mismatch
• Tax Identification Numbers: SSN and FEIN (Federal Employer Identification Number)
• Disclosures

• Find Your Provider Type
• Enrollment Types
• Enrollment Application