The Health Insurance Portability and Accountability Act (HIPAA) requires that covered entities (i.e.,
health plans, health care clearinghouses, and those health care providers who transmit any health
information electronically in connection with a transaction for which the Secretary of Health and Human
Services has adopted a standard) use NPIs in standard transactions.
Paper Claims
Electronic claims format shall be required unless hard copy claims submittals are specifically prior
authorized by the Department. Requests may be sent to the Department’s fiscal agent, Xerox State
Healthcare, P.O. Box 30, Denver, CO 80201-0090. The following claims can be submitted on paper and
processed for payment:
Claims from providers who consistently submit 5 claims or fewer per month (requires prior
approval)
Claims that, by policy, require attachments
Reconsideration claims
Paper claims do not require an NPI, but do require the Colorado Medical Assistance Program provider
number. In addition, the UB-04 Certification document must be completed and attached to all claims
submitted on the paper UB-04. Electronically mandated claims submitted on paper are processed,
denied, and marked with the message “Electronic Filing Required”.
Interactive Claim Submission and Processing
Interactive claim submission through the Web Portal is a real-time exchange of information between the
provider and the Colorado Medical Assistance Program. Colorado Medical Assistance Program providers
may create and transmit HIPAA compliant 837P (Professional), 837I (Institutional), and 837D (Dental)
claims electronically one at a time. These claims are transmitted through the Colorado Medical
Assistance Program OnLine Transaction Processor (OLTP).
