Colorado Medicaid Behavioral Health Billing: 5 Easy Steps
Colorado Medicaid behavioral health billing runs through regional organizations, not one state claims desk. Health First Colorado, the state’s Medicaid program, pays for behavioral health through a capitated benefit that Regional Accountable Entities (RAEs) manage. That means your contract, your claims and your rates depend on which RAE covers the patient in front of you.
Who pays for Colorado Medicaid behavioral health billing
The Colorado Department of Health Care Policy and Financing (HCPF) says RAEs administer the capitated behavioral health benefit and build the provider networks, while physical health is managed fee-for-service. Behavioral health providers bill the RAE for behavioral health care, according to an HCPF presentation from September 2025. HCPF’s Accountable Care Collaborative Phase III page shows four regions that began July 1, 2025.
| Where the member is enrolled | Who manages behavioral health |
|---|---|
| Region 1 | Rocky Mountain Health Plans (RMHP), including RMHP PRIME |
| Region 2 | Northeast Health Partners |
| Region 3 | Colorado Community Health Alliance |
| Region 4 | Colorado Access |
| Elevate (Denver Health) Medicaid Choice | Colorado Access manages behavioral health; Elevate covers physical health |
Use insurance verification on every Health First Colorado member to find the RAE or plan before the first visit. Our eligibility verification guide explains the electronic check. Assignment can change, because HCPF’s fact sheet says members are assigned by the location of their primary care provider or by home address, so re-check coverage regularly.
How Colorado Medicaid behavioral health billing differs by payer
Medicare and Medicaid
For Medicaid, the first job is a contract. HCPF’s behavioral health provider fact sheet (October 2025) says providers need a contract with a specific RAE, or a single case agreement, to serve its members, and that providers can contract with more than one RAE. Ask each RAE about network needs before you add services that need a new contract. Our credentialing page explains enrollment.
Four details change daily work:
- Routing. The fact sheet says some services, psychiatry among them, are billed to the member’s managed care organization instead of HCPF fee-for-service. If you prescribe, ask the RAE how your evaluation and management (E/M) visits and psychotherapy add-on codes route.
- Edits. Starting October 1, 2025, RAEs must apply National Correct Coding Initiative (NCCI) edits plus Colorado-specific medically unlikely edits and procedure-to-procedure edits.
- Rates. Some RAEs updated provider contracts or rates, and HCPF no longer sets directed payments for outpatient behavioral health essential safety net services except for a limited list. Ask each RAE for its fee schedule.
- Timely filing. An HCPF Medical Services Board document (rule MSB 25-07-28-A) proposes raising the Medicaid timely filing limit from 120 to 365 days from the date of service, with a proposed effective date of August 8, 2025. Check each RAE contract for its own limit.
For Medicare, Medicare.gov lists psychiatrists, clinical psychologists, clinical social workers, marriage and family therapists and mental health counselors among outpatient mental health providers. Medicare follows its own rules, separate from Health First Colorado.
Private payers
Colorado commercial plans set their own contracts, fee schedules and filing limits, and this guide does not cover them. Read each contract, and see in-network vs out-of-network credentialing if you are deciding which plans to join.
State rules
HCPF is the state agency that runs Health First Colorado and sets the Accountable Care Collaborative (ACC) rules. Phase III cut the RAE regions from seven to four on July 1, 2025, according to HCPF, so many practices now hold contracts with fewer organizations. Behavioral Health Secure Transport services also moved to the RAEs, so providers who billed HCPF for them now contract with a RAE.
Who do I bill for Health First Colorado behavioral health?
For Colorado Medicaid behavioral health billing, bill the member’s RAE for behavioral health care, unless the member is in a managed care plan that handles it. Elevate members use Colorado Access for behavioral health, and RMHP PRIME members use Rocky Mountain Health Plans. Find the plan in the eligibility check, then confirm the payer ID and portal with that plan.
Checklist for Colorado Medicaid behavioral health billing
Run this list for every new member so Colorado Medicaid behavioral health billing stays consistent.
- Verify Health First Colorado eligibility and write down the RAE or plan.
- Confirm your contract or single case agreement with that RAE.
- Check the fee schedule and the filing limit in the contract.
- Run code pairs against NCCI and Colorado edits before you submit.
- Read the remittance with our guide to electronic remittance advice, and track results against your clean claim rate.
What to do Monday morning
- Pull a list of your Health First Colorado patients and the RAE for each.
- Match each RAE to a signed contract or single case agreement.
- Flag any denial for a psychotherapy add-on code and ask the RAE how it expects the claim built.
- Put each RAE’s filing limit and portal on one page at the billing desk.
The short version: Colorado Medicaid behavioral health billing
Colorado Medicaid behavioral health billing starts with the RAE. Verify who manages the member’s behavioral health, hold a contract with that RAE, and follow its edits, rates and filing limit. Medicare and commercial plans follow separate rules.
How MCM South helps
MCM South Medical Billing Service, LLC bills for psychotherapists and psychiatrists, including out-of-network claims, and Colorado is one of our ten currently served states. If RAE contracts and edits are slowing your claims, ask for a quote and we will talk through your practice.
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FAQ
What is a RAE in Health First Colorado?
A Regional Accountable Entity (RAE) is a regional organization that HCPF contracts to administer the capitated behavioral health benefit, build the provider network and coordinate care. There are four RAE regions, which began July 1, 2025.
Do I need a contract with a RAE to treat Health First Colorado members?
HCPF’s October 2025 fact sheet says providers need a contract with a specific RAE, or a single case agreement, to serve its members. You can contract with more than one RAE.
What is the Medicaid timely filing limit in Colorado?
An HCPF Medical Services Board document proposes 365 days from the date of service, up from 120, with a proposed effective date of August 8, 2025. RAE contracts can set their own limits, so check your contract.
Do psychiatrists bill Health First Colorado the same way as therapists?
Not always. The HCPF fact sheet gives psychiatry as an example of a service billed to the member’s managed care organization instead of HCPF fee-for-service. Ask the RAE how your evaluation and management visits and add-on codes route.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
