2015 Provider Contact Information

2015 Provider Contact Information
Colorado HealthOP Provider Customer Service: For member eligibility, explanation of benefits, claim status, reconsiderations and plan participation call 866-785-7265. For members needing
assistance have them call 866-915-6619.
Provider Relations: For credentialing and provider education resources please
contact [email protected].
Benefit Determination: call 866-785-7265
To determine if a member is eligible for selected ambulatory procedures and services,
prior to rendereing the services please call the number listed above.
Pre-Certification/Prior Authorization:
For Pre-Certification and Prior Authorization call 888-893-6756 for EPO and 888-893-7264 for
PPO.
Pre-Certification- Medical necessity determination. This requires judgment or
interpretation for benefit coverage. Determination of coverage is based on plan documents,
information from the provider, information from nationally recoginzed guidelines.
Prior Authorization- This should be done by the patient or provider notifying us that they
are going to do something to/with our member. We want to know about this services ahead
of time.
For a full list of Pre- Certification and Prior Authorization please visit our website at
www.cohealthop.org.
Formularies: WellDyne- 866-842-4811
Claims: 866-785-7265
Colorado HealthOP
P.O. Box 14327
Reading, PA 19612-4327
Attn: Claims
Payer ID 49718
5000_MEMB402_ENG_141124_C