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CHP+ Managed Care Network
CHP+ Managed Care Network
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!

Why participate as a provider in CHP+?
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.
How does the CHP+ Managed Care Network work?
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 enrollment period.

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+ members.

Choice:
Colorado Access, Denver Health, Kaiser

Colorado Access Only

Rocky Mountain HMO Only

Mixed

CHP + State Managed Care Network Only

CHP+ State Managed Care Network & Colorado Access

Adams  DH

Alamosa

Delta

Bent

Mineral

Archuleta

Hinsdale

Pitkin

Arapahoe DH

Costilla

Mesa

Clear Creek

Morgan

Baca

Jackson

Rio Blanco

Boulder  DH

Gilpin

Montrose

Conejos

Otero

Chaffee

Kit Carson

Routt

Broomfield DH

Kiowa

 

Crowley

Park

Cheyenne

Lake

San Juan

Denver DH

Logan

 

Custer

Pueblo

Dolores

La Plata

San Miguel

Douglas  DH

Phillips

 

Elbert

Rio Grande

Eagle

Las Animas

Sedgwick

Jefferson DH

Prowers

 

Fremont

Washington

El Paso

Moffat

Summit

 

Saguache

 

Huerfano

Yuma

Garfield

Montezuma

Teller

 

Weld

 

Larimer

 

Grand

Ouray

 

 

 

 

Lincoln

 

Gunnison

 

 


How can you determine which HMO a CHP+ member belongs to?
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+ Benefits Booklet. 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.

What are the requirements and responsibilities of CHP+ providers?
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)



State Managed Care Network Customer Service
PO Box 17580 Denver, CO 80217-0580
Phone: (303) 751-9051
Toll Free: 1-800-414-6198
Send claims to:
CHP+ Claims
PO Box 17470
Denver, CO 80217-0470