Click here for Fluoride Varnish Resource Sheet.
Click here for Oral Health Preventive Care Toolkit.
Click here for Essential Community Provider (ECP) Certification Information.
Click here for CHP+ Retro Eligibility Claim Processing Guidelines.
- Click here for the Application Form
- Click here for the FAQs
Click here for Childhood Immunization Services provided by Colorado Local Public Health Agencies.
Click here to download the updated member Grievance and Appeal procedures.
Click here to download the SMCN Copay Increase table.
Click here to download the CHP+ Provider Manual.
Click here to download the Provider Questionnaire.
The purpose of this questionnaire is to have the most accurate and up-
to-date information to ensure you receive reimbursement in a timely
manner. Please complete and return this questionnaire with your
signed contracts. Thank you
Click here to download the CHP+ Notification of Other Insurance Form.
Note: This form is for CHP+ provider use only and
should be used when a current CHP+ member is also enrolled in another health insurance program.
Use this form for clients who wish to add a member to their CHP+ policy (such as a newborn baby.)
Click here to go to the CHP+ Add Baby Request Form.
Please complete this form if your legal name, service location or your
taxpayer identification number (TIN) has changed and does not match your
current contract information.
Click here to download the CHP+ Provider Address Change Form.
Please complete and submit this form to add or terminate a provider
from your practice or organization.
Click here to download the CHP+ Provider Clinical Staff Update Form.
Please complete the Synagis Prior Authorization form and prescription and fax to Avella Pharmacy at 877-470-7604 for each patient. Please indicate whether this will be administered in your office or the patient's home.
Click here to download the CHP+ Provider Synagis Prior Authorization Form.
CHP+ has a wide range of free materials for distribution that contain helpful information for families interested in the programs. CHP+ offers applications, brochures and brochure holders, and posters for distribution and display across the state.
Click here to access the CHP+ site directly!
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