Get How To Write A Load Letter

This guide provides clear and supportive guidance on filling out the How To Write A Load Letter. By following these steps, users can ensure that their requests are completed accurately for timely processing.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to access the Load Letter form and open it in your preferred online editor.
2. Enter today’s date in the space provided at the top of the form.
3. Fill in the client information section, including the State Medicaid ID, date of birth, social security number, last name, and first name.
4. Specify the dates of service that are to be covered in the request.
5. Leave the section labeled 'For Department Use Only' blank as instructed.
6. Indicate the county of residence and the Medicaid verification of eligibility date.
7. Enter the case number if you have it available.
8. Provide the details of the provider to whom the Load Letter will be returned, including the provider's name, Medicaid ID, contact name, email, phone number, and fax number.
9. If you represent a Behavioral Health Organization, check the designated box; otherwise, leave it unchecked.
10. In the section provided at the bottom of the form, briefly explain any circumstances that caused a delay in billing beyond the 120 days timely billing cycle.
11. Once you have completed the form, save your changes. You can then download or print the form, and email it securely to loadletterrequests@hcpf.state.co.us, or fax it to 303-866-2082.

Complete your Load Letter request online to ensure timely processing.