Effective January 1, 2013, there will be material changes to the Current Procedural Terminology (CPT) codes for psychiatry services. This is important information for all providers. Please click here for more information.
Important Notice: In order to align with the State's payment structure, Colorado Access will also be implementing the APR-DRG methodology. The effective date of this implementation will be July 1, 2014 and will impact all inpatient claims with a discharge date of 7-1-14 and forward. This change will apply to CHP+ State Managed Care Network CHP+. Click here for details..
The Child Health Plan Plus (CHP+) relies on dedicated providers like you to serve the health
care needs of Colorado's low-income children and pregnant women enrolled in the program. By participating in CHP+,
you are joining a network of providers throughout the State whose efforts and commitment have resulted in a
significant increase in the number of Colorado families who have access to appropriate health care. Without the
participation of providers like you, this program would not be possible!
Participating in the program allows you to:
- Provide preventive and early appropriate care for children and pregnant women with no regular access to health care
- Receive payment for the care of children and pregnant women for whom you now provide free care
- Reduce inappropriate use of emergency departments
- Provide a medical home for more of Colorado's children and pregnant women.
- Renewal Letter
The State of Colorado, Department of Health Care Policy and Financing (the Department) administers the
CHP+ program. Health Maintenance Organizations (HMOs) contract with The Department to provide medical services to CHP+
members. The Division of Insurance approves services areas for the HMOs based on the HMOs provider network adequacy
in the areas. The CHP+ Managed Care Network functions much like a traditional HMO operated by The Department.
Colorado Access performs the contract administration duties with providers on behalf of The Department.
The ability of a CHP+ member to select a particular HMO is dependent on where the CHP+ member resides. A
pre-HMO enrollment period is the span of time from a member's original enrollment until the member is
enrolled in a CHP+ participating HMO. The CHP+ Managed Care Network delivers care during this span or pre-HMO
The following table lists the counties and respective HMO affiliations:
CHP+ Managed Care Network Only Counties. In counties where the CHP+ Managed Care Network is the only
available health plan, providers enter into a contract with The Department.
Mixed Counties. In counties where the CHP+ Managed Care Network and other HMOs are available (Mixed),
providers may choose to enter into a contract with The Department, the HMO, or both. However, for continuity of care issues,
providers are strongly recommended to enter into a contract with The Department for the purposes of providing medical care to
CHP+ members during the pre-HMO enrollment period when the CHP+ Managed Care Network serves CHP+ members.
Rocky Mountain HMO Only and Colorado Access Only Counties. In counties where only one HMO is
available (for example, Rocky Mountain HMO only or Colorado Access only), providers must enter into a contract with
that designated HMO. However, for continuity of care issues, providers are also strongly recommended to enter into
a contract with The Department for the purposes of providing medical care to CHP+ members during the pre-HMO enrollment period
when the CHP+ Managed Care Network serves CHP+ members.
Choice Counties. In counties where there is a choice of HMOs in the CHP+ member's county of residence,
providers must enter into a contract with at least one of the designated HMOs. However, for continuity of care
issues, providers are also strongly recommended to enter into a contract with The Department for the purposes of providing
medical care to CHP+ members during the pre-HMO enrollment period when the CHP+ Managed Care Network serves CHP+
Colorado Access or Kaiser
Colorado Access, Denver Health, Kaiser
Colorado Access or Colorado Choice Health Plan
Colorado Access Only
Rocky Mountain Health Plan Only
Colorado Choice Health Plan Only
**This information applies to children that have CHP+HMO. If you are pregnant, have Presumptive Eligibility or are Pre-HMO, you are on the State Managed Care Network and are active in any county.
The ability of a CHP+ member to select a particular HMO is
dependent on where the CHP+ member resides. A pre-HMO enrollment period is the
span of time from a member's application date until the
member is enrolled in a CHP+ participating HMO.
The State Managed Care Network delivers
care during this span or presumptive eligibility period.
State Managed Care Network is available in all counties during the
presumptive eligibility and pre-HMO enrollment periods, as well as
enrollments for prenatal clients.
- Colorado Choice Health Plan starts as an HMO to provide service to CHP+
children in Alamosa, Bent, Chaffee, Conejos, Costilla , Crowley,
Custer, Freemont, Huerfano, Las Animas, Mineral, Otero, Prowers,
Rio Grande, Saguache, and Yuma counties.
- Colorado Access will be the only HMO to provide service to CHP+
children in Clear Creek, Elbert, Larimer, Lincoln, Morgan, Park, Pueblo,
and Washington counties
- Rocky Mountain Health Plan expands service to CHP+ children in
Archuleta, Dolores, Eagle, Grand, Gunnison, Hinsdale, Jackson, Lake, Moffat,
Ouray, Pitkin, Rio Blanco, Routt, San Juan, San Miguel, and Summit counties.
- Colorado Choice Health Plan expanded into five additional counties;
Baca, Cheyenne and Kit Carson will become a Colorado Choice HMO only county.
Also expansion into Kiowa and Washington counties which
they will share with Colorado Access CHP HMO.
**Please note the CHP+ State Managed Care Network is no longer available
as an HMO to children in these counties.
For those CHP+ members enrolled in a HMO other than the CHP+ Managed Care Network, CHP+ members
will receive a temporary medical insurance card valid until a permanent card is received from the CHP+ member's HMO.
Those CHP+ members enrolled in the CHP+ Managed Care Network will receive a medical insurance card and a CHP+
CHP+ Customer Service is available to answer any questions regarding a CHP+ member's eligibility at 800.359.1991
between the hours of 8 am - 6 pm.
CHP+ providers are responsible and required to:
- Accept members, without regard to health status or health care needs
- Not differentiate or discriminate in the treatment of members or
in the quantity or quality of services
delivered to members on the basis of race, sex, age, religion,
or source of payment
- Observe, protect and promote the rights of members as patients
- Abide by all applicable Federal and State of Colorado laws and regulations,
in the performance of their work evidenced by
current licenses to provide care to members
- Obtain and maintain such policies of general liability, professional
liability and other insurance as necessary
- Maintain a current contract with CHP+
- Agree to provide all medically necessary covered services to members
- Make necessary and appropriate arrangements to ensure the availability of covered services to
members 24 hours a day, seven days a week (applicable only to Primary Care Providers)