UPDATED​ ​03/12/17

Provider​ ​Web​ ​Portal​ ​Cheat​ ​Sheet​ ​-​ ​Verifying​ ​Member Eligibility​ ​and​ ​Co-payment​ ​(including​ ​MCO/BHO assignments,​ ​ACC,​ ​&​ ​PCMP) 1. Login​ ​to​ ​Provider​ ​Web​ ​Portal 2. Click​ ​Eligibility

Page​ ​1​ ​of​ 7 ​

VERIFYING​ ​MEMBER​ ​ELIGIBILITY PROVIDER​ ​WEB​ ​PORTAL​ ​CHEAT​ ​SHEET

3. Click​ ​Eligibility​ ​Verification​ ​again

4. Enter​ ​search​ ​Criteria​ ​and​ ​click​ ​Submit

Page​ ​2​ ​of​ 7 ​

VERIFYING​ ​MEMBER​ ​ELIGIBILITY PROVIDER​ ​WEB​ ​PORTAL​ ​CHEAT​ ​SHEET

5. Review​ ​Search​ ​Results Scroll​ ​down​ ​to​ ​see​ ​high-level​ ​eligibility​ ​info​ ​–​ ​this​ ​member​ ​is​ ​eligible​ ​for​ ​Medicaid​ ​State​ ​Plan,​ ​Behavioral​ ​Health, HCBS​ ​EBD​ ​Waiver,​ ​and​ ​QMB. Click​ ​on​ ​any​ ​of​ ​the​ ​lines​ ​(they​ ​will​ ​all​ ​show​ ​you​ ​the​ ​same​ ​information)​ ​for​ ​detail​ ​-​ ​co-Pay​ ​info,​ ​MCO assignments,​ ​and​ ​PCMP​ ​info.

6. Scroll​ ​to​ ​the​ ​bottom​ ​of​ ​any​ ​detail​ ​page​ ​to​ ​see​ ​Managed​ ​Care​ ​Assignments​ ​and PCMP Click​ ​the​ ​plus​ ​sign​ ​next​ ​to​ ​Managed​ ​Care​ ​Assignment​ ​Details.

Managed​ ​Care​ ​Assignment​ ​Details​ ​and​ ​PCMP​ ​(APCMP​ ​below)​ ​details:

Note:​ ​If​ ​“Denver​ ​Health​ ​and​ ​Hospital​ ​Authority”​ ​is​ ​listed​ ​under​ ​Managed​ ​Care​ ​Assignment​ ​Details,​ ​that​ ​doesn’t necessarily​ ​indicate​ ​that​ ​the​ ​member​ ​is​ ​a​ ​part​ ​of​ ​the​ ​MCO​ ​Denver​ ​Health​ ​Medicaid​ ​Choice.​ ​If​ ​a​ ​Member​ ​is​ ​part of​ ​the​ ​MCO​ ​Denver​ ​Health​ ​Medicaid​ ​Choice,​ ​it​ ​will​ ​say​ ​“Denver​ ​Health​ ​Medicaid​ ​Choice​ ​(PHIP).

Page​ ​3​ ​of​ 7 ​

VERIFYING​ ​MEMBER​ ​ELIGIBILITY PROVIDER​ ​WEB​ ​PORTAL​ ​CHEAT​ ​SHEET

7. To​ ​verify​ ​member​ ​co-payment​ ​requirements The​ ​Department’s​ ​co-payment​ ​policy​ ​has​ ​been​ ​recently​ ​updated.​ ​Some​ ​members​ ​may​ ​not​ ​be​ ​required​ ​to​ ​pay​ ​a co-payment​ ​every​ ​visit,​ ​so​ ​please​ ​check​ ​the​ ​co-payment​ ​information​ ​every​ ​time​ ​you​ ​see​ ​a​ ​Health​ ​First Colorado​ ​member. If​ ​the​ ​member​ ​is​ ​required​ ​to​ ​pay​ ​a​ ​co-payment,​ ​it​ ​will​ ​be​ ​listed​ ​under​ ​benefit​ ​details​ ​on​ ​the​ ​web​ ​portal.​ ​If​ ​the member​ ​has​ ​reached​ ​their​ ​5%​ ​co-payment​ ​maximum​ ​for​ ​a​ ​given​ ​month,​ ​it​ ​will​ ​say​ ​“member​ ​is​ ​co-pay exempt”.

Page​ ​4​ ​of​ 7 ​

VERIFYING​ ​MEMBER​ ​ELIGIBILITY PROVIDER​ ​WEB​ ​PORTAL​ ​CHEAT​ ​SHEET

8. To​ ​see​ ​Third​ ​Party​ ​Liability​ ​Coverage​ ​(including​ ​Medicare) Go​ ​back​ ​to​ ​the​ ​Eligibility​ ​Verification​ ​page

9. Scroll​ ​to​ ​bottom​ ​of​ ​page​ ​and​ ​click​ ​“Other​ ​Insurance​ ​Detail​ ​Information”

10. This​ ​is​ ​where​ ​you​ ​will​ ​find​ ​Other​ ​insurance​ ​coverage​ ​(including​ ​Medicare coverage)

Page​ ​5​ ​of​ 7 ​

VERIFYING​ ​MEMBER​ ​ELIGIBILITY PROVIDER​ ​WEB​ ​PORTAL​ ​CHEAT​ ​SHEET

11.

Adding​ ​additional​ ​Third​ ​Party​ ​Liability​ ​(TPL)​ ​info

If​ ​member​ ​has​ ​Third​ ​Party​ ​Liability​ ​(TPL)​ ​coverage​ ​that​ ​isn’t​ ​listed,​ ​you​ ​have​ ​the​ ​ability​ ​to​ ​add​ ​that​ ​information by​ ​completing​ ​the​ ​form​ ​and​ ​clicking​ ​Add.​ ​The​ ​information​ ​you​ ​enter​ ​goes​ ​through​ ​a​ ​process​ ​to​ ​be​ ​verified,​ ​and once​ ​verified​ ​will​ ​become​ ​part​ ​of​ ​that​ ​member’s​ ​record.

Need​ ​More​ ​Help? Other​ ​Provider​ ​Web​ ​Portal​ ​Cheat​ ​Sheets: Aid​ ​Code​ ​and​ ​Benefit​ ​Plan​ ​Acronyms Are​ ​you​ ​Billing​ ​from​ ​the​ ​Correct​ ​Account? Copy,​ ​Adjust,​ ​or​ ​Void​ ​a​ ​Claim Delegates Delegate​ ​Access​ ​Definitions Pulling​ ​your​ ​835​ ​–​ ​linking​ ​to​ ​your​ ​own​ ​TPID Pulling​ ​your​ ​Remittance​ ​Advice​ ​(RA) Provider​ ​Maintenance Updating​ ​your​ ​EFT/ERA​ ​Information Validating​ ​a​ ​Trading​ ​Partner​ ​ID​ ​(TPID) Verifying​ ​Member​ ​Eligibility,​ ​including: ● Managed​ ​Care​ ​Assignments ● Primary​ ​Care​ ​Provider Page​ ​6​ ​of​ 7 ​

VERIFYING​ ​MEMBER​ ​ELIGIBILITY PROVIDER​ ​WEB​ ​PORTAL​ ​CHEAT​ ​SHEET

● Medicare​ ​Coverage ● Member​ ​Co-pay​ ​amounts Web​ ​Portal​ ​Registration

Provider​ ​Web​ ​Portal​ ​–​ ​Frequently​ ​Asked​ ​Questions​ ​(FAQs)

Please​ ​visit​ ​our​ ​Provider​ ​Web​ ​Portal​ ​information​ ​page​ ​at:​ ​Colorado.gov/HCPF/web-portal

Provider​ ​Web​ ​Portal​ ​–​ ​Recorded​ ​Webinars

Click​ ​the​ ​links​ ​below​ ​to​ ​access​ ​the​ ​recorded​ ​webinars: Session​ ​#1

Access​ ​the​ ​new​ ​Portal,​ ​Portal​ ​Registration,​ ​Log​ ​in,​ ​My​ ​Profile,​ ​Manage​ ​Accounts (including​ ​delegates)

Session​ ​#2

Provider​ ​Maintenance​ ​(including​ ​updates​ ​and​ ​affiliations),​ ​EFT/ERA​ ​Enrollment,​ ​Disenroll

Session​ ​#3

Member​ ​Information​ ​and​ ​Eligibility​ ​Verification

Session​ ​#4

Remittance​ ​Advice​ ​(RA),​ ​Search​ ​Payment​ ​History,​ ​Search​ ​for​ ​Accounts​ ​Receivable Records,​ ​Make​ ​a​ ​Payment

Session​ ​#5

Notify​ ​Me,​ ​Alerts,​ ​Secure​ ​Correspondence

Session​ ​#6

Files​ ​Exchange,​ ​Resources

Session​ ​#7

Search​ ​&​ ​Submit​ ​CMS​ ​1500,​ ​UB-04,​ ​Emergency​ ​Dental​ ​Claims,​ ​Prior​ ​Authorizations (Nursing​ ​Facility​ ​PETI​ ​PARs​ ​only)

Bridge

Bridge​ ​training​ ​for​ ​Community​ ​Centered​ ​Boards​ ​(CCBs)​ ​only

Page​ ​7​ ​of​ 7 ​