MedicaidAdministrativeHigh impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600535 - 03/2026)
Colorado Medicaid·CO · Psychiatry, Neurology·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Colorado Medicaid has implemented several critical changes including reduced timeframes for prior authorization responses (7 calendar days instead of 10 business days), mandatory SC modifiers for psychological testing codes to bill fee-for-service, and new EDI vendor transition requirements for clearinghouses and billing agents.
Action Required
Immediately: 1) Billing team must add SC modifier to CPT codes 96130, 96131, 96136, 96137 for all psychological testing claims to process under fee-for-service - claims without SC modifier will be denied. 2) Resubmit any previously denied psychological testing claims with SC modifier. 3) Update prior authorization submission processes to include ALL required documentation upfront as pends are reduced to 7 calendar days with no extensions allowed. 4) Coordinate with clearinghouse/billing vendors to ensure they are prepared for EDI platform transition to Edifecs starting summer 2026.