Credentialing in Colorado
Soft Home Global provides payer enrollment, revalidation and follow-up for Colorado practices and billing companies at $2,200 per seat per month. Full time, worked during Colorado business hours, inside your own system.
What is specific to Colorado
Health First Colorado runs through the Accountable Care Collaborative, where Regional Accountable Entities coordinate care and hold the behavioral health benefit while most physical health claims are still paid fee-for-service by the state.
Colorado’s Medicaid program is Health First Colorado. Practices with a meaningful Health First Colorado mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by Novitas Solutions, jurisdiction JH — shared with New Mexico and Oklahoma, but not with Arizona (Noridian), Kansas (WPS), Nebraska (WPS), Utah (Noridian) or Wyoming (Noridian). CMS publishes the jurisdictions; checked September 2026.
What a credentialing seat does in Colorado
Applications, revalidations and payer follow-up, with every enrollment's status visible.
Health First Colorado is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during Colorado business hours, not queued overnight
For the statute behind all of this — Colorado’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Colorado billing page.
Health First Colorado, in practice
Health First Colorado runs no comprehensive risk-based MCOs — in CMS's 2024 managed-care enrollment file Colorado's only non-PACE managed care is the 'Accountable Care Collaborative (PCCM Entity),' delivered through seven Regional Accountable Entities (listed as RAE 1 Rocky Mountain Health Plans, RAE 2 Northeast Health Partners, RAE 3 and RAE 5 Colorado Access, RAE 4 Health Colorado Inc., RAE 6 and RAE 7 Colorado Community Health Alliance) plus Denver Health Medicaid Choice and Rocky Mountain Health Plans PRIME. Source: Medicaid.gov data
Colorado sets a hard 90-day outer deadline on every claim, not just clean ones — a pended, disputed or additional-information claim still has to be resolved within 90 calendar days of receipt. Verbatim, C.R.S. 10-16-106.5(4)(c): 'Absent fraud, all claims except those described in paragraph (a) of this subsection (4) shall be paid, denied, or settled within ninety calendar days after receipt by the carrier.' Colorado also requires carriers to run a receipt-confirmation mechanism for non-electronic claims and to list the claim on it within ten business days, with that listing date deemed the date of receipt — which gives a biller a documented start date for the prompt-pay clock on paper claims. Source: FindLaw state code
For enrolment that is not a detail, it is a second application. A carved-out benefit is administered by a different organisation, which credentials separately, on its own timetable, and a provider who is live everywhere else can still be out of network for that one service without anybody noticing until the first claim is denied.
Working Colorado hours
Colorado runs on Mountain time, 12 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 9pm to 5am, and 8pm to 4am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Colorado hours and nobody else’s.
What it costs in Colorado
$2,200
Per seat, per month, in US dollars — $26,400 a year for one full-time person, forty hours a week, on Colorado hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Colorado run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Colorado
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Colorado practices?
Yes. Colorado accounts are worked during Colorado office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Colorado?
Health First Colorado runs through the Accountable Care Collaborative, where Regional Accountable Entities coordinate care and hold the behavioral health benefit while most physical health claims are still paid fee-for-service by the state.
Which Medicare Administrative Contractor covers Colorado?
Novitas Solutions, the A/B MAC for jurisdiction JH. It processes Medicare enrollment applications for providers here, and it sends the revalidation notice two to three months before the due date.
When does a Colorado payer have to pay a clean claim?
30 calendar days for clean claims submitted electronically; 45 calendar days for clean claims submitted by any other means (C.R.S. 10-16-106.5(4)(a)) It runs from receipt of a clean claim, so claims held back while a provider’s enrollment is pending have not started it.
How often do Colorado providers have to revalidate?
Medicare: every five years, with sixty days to submit once Novitas sends the notice (42 CFR 424.515). Health First Colorado: federal rule requires the state to revalidate every provider at least every five years (42 CFR 455.414), and the state agency sets the exact schedule. A Medicare revalidation left unanswered deactivates billing privileges, and claims stop with it.
How much does credentialing cost in Colorado?
$2,200 per seat per month — $26,400 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Colorado queue?
Colorado is on Mountain time, 12 hours behind Rawalpindi. The shift here runs 9pm to 5am so your seat is at a desk for your full working day, shifting to 8pm to 4am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Health First Colorado as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Health First Colorado has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
Next step
One seat on your Colorado work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com