Medical Credentialing Services in Colorado

Medical credentialing in Colorado, like in many other states, is a crucial process that ensures healthcare providers meet specific qualifications and standards to practice medicine safely and effectively. The Colorado Medical Board oversees medical credentialing and licensing within the state.

To become credentialed in Colorado, healthcare providers, including physicians, physician assistants, and nurses, must submit a comprehensive application that includes their educational background, training, licensure, and work history.

What’s Unique About Medical Credentialing in Colorado

1. Uniform State Application Repealed

Until March 2023, providers seeking medical credentialing in Colorado were required to submit a uniform application (Colorado Health Care Professionals Credentials Application). The legislature repealed this regulation paving the way for providers and entities to use platforms such as CAQH to more easily manage data.

2. Additional Medicaid Requirements

Providers who participate in the Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid program) are required to submit the enrollment fee ($688 in 2023) with their application. If the provider is considered by the state of Colorado to be high-risk or an owner of high-risk providers, a fingerprint criminal background check is also required for both new and existing enrollments. Revalidation every five years is required for providers to remain enrolled.

3. Controlled Substance Licensure

Colorado has a one license requirement for controlled substance licensure. When completing healthcare credentialing, it is important to check Colorado’s prescriptive/drug procurement authority table to understand what is required for every role within your organization.

Steps To Complete Provider Credentialing in Colorado

Here are the general steps involved in completing medical credentialing in the state of Colorado:

Set Up Online Portals. Ensure the provider’s CAQH profile is up-to-date and if the provider will be enrolling with Medicare and Health First Colorado, set up those portals as well.
Primary Source Verification. Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications provided by the provider. Payers in Colorado have specific requirements.
Work History and Reference Checks. To assess the provider’s experience and reputation within the healthcare community, the work history of the provider must be verified without any gaps longer than 30 days.
Background Checks. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags.
Payer Enrollment. Providers must be enrolled with every payer they accept insurance from — again, before they start seeing patients. With an average of 5 – 10 payers per provider, this can be a time-consuming and tedious step that needs to start early in the credentialing process.
Privileging. Privileging involves the collection and review of a provider’s documentation to determine if they’re worthy to provide care to patients within a specific institution. All providers must receive privileges at the facility where they will see patients before they begin practicing.

Tips To Speed Up Credentialing in Colorado

The time it takes to credential providers in Colorado can vary depending on a variety of factors. Generally speaking, you should plan for several weeks at a minimum to complete the credentialing process from start to finish. The exact timeline depends heavily on the provider’s specialty, volume of providers, and the efficiency and completeness of the provider’s documentation.

1. Start as soon as the provider is hired.

Make sure you start collecting documents as soon as possible and, if enrolling with Health First Colorado, encourage the provider to set up a provider portal. Credentialing early will also alert you to any red flags or complications early in the hiring and onboarding process.

2. Make it easy for providers to submit documents.

It is much easier for you and the provider, to request digital documents as opposed to collecting a paper credentialing packet. Credentialing software offers the ability for providers to securely submit documents to an online portal.

3. Set a process specific to Colorado’s payers.

Payers, such as Anthem Blue Cross Blue Shield, all have specific requirements for the state in which they are located. Understanding this process and creating checklists for each payer will help you to complete medical credentialing in Colorado much more quickly. A process (workflow) ensures continuity in case the credentialing expert is out of the office or has moved on.

4. Set reminders and notifications.

Scheduling reminders for follow-ups can help you shave hours or weeks off your credentialing process. There’s likely to be a lot of back-and-forth in verifying information, so be sure to schedule reminders every time there’s an additional step required to complete the action. Credentialing software can automate these reminders to ensure you don’t miss steps or deadlines.

Keep Credentialing Organized for Colorado Providers

Using medical credentialing services in Colorado can help to speed up the process because these credentialing specialists are used to the rules and regulations. In many cases they have also developed good working relationships with the payers, which can smooth the process.

Find out how MedTrainer can help — whether you just need software or you’re looking for credentialing services to handle the process for you.