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  • Service Authorization Form (css01) - Colorado Access

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Service Authorization Form (CSS01) (Bolded lines must be completed where applicable) You may call us at 1-800-511-5010 or 720-744-5100 Fax this form toll free to:1-877-232-5976 or 303-755-4135 Stamp.

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If you already receive EFT through Change Healthcare for other payers, you will still need to select/add Colorado Access (payer ID 84129) • To sign up for EFT, please go to https://legacy.changehealthcare.com/home/legacy/resources/ enrollment-services/medical-hospital-enrollment/eft-enrollment#eftenrollment.

Child Health Plan Plus (CHP+) offered by Colorado Access is a low-cost health insurance plan for children through age 18 and pregnant women. If you make too much to qualify for Medicaid, your family might qualify.

Starting in 1998, we began serving low-income children through Child Health Plan Plus (CHP+) offered by Colorado Access. As the State's largest CHP+ Managed Care Organization (MCO), the plan currently serves children in 44 counties up and down the Front Range and in the Eastern Plains.

You may also find out if you qualify through the Marketplace application. To learn more about the program, please visit the About CHP+ website....Colorado Child Health Plan Plus (CHP+)? Household Size*Maximum Income Level (Per Year)1$36,4502$49,3003$62,1504$75,0004 more rows

Although CHIP covers more children, its coverage options are more limited than Medicaid. CHIP doesn't offer coverage for EPSDT services. CHIP was designed to cover children who fall outside of Medicaid eligibility, but who otherwise were not able to be insured through a family plan.

Be sure to file within the timely filing limit, which is 120 days from the date of service or the time limit specified in your contract. 4. You can check the status of a Colorado Access claim through our provider portal.

Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Health First Colorado (Colorado's Medicaid program), but not enough to pay for private health insurance.

Colorado Access is a nonprofit health plan. We have many programs to help you take charge of your health. Colorado Access helps Health First Colorado (Colorado's Medicaid Program) members in Denver County. We also help members outside Denver County if they get primary care from one of our providers.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232