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244 8.125.7.E. The Department may exempt certain providers from all or part of the screening requirements when certain providers have been screened, approved and enrolled or revalidated: 1. By Medicare, or 2. By another state’s Medicaid program within the last 5 years, provided the Department has determined that the state in which the provider was enrolled or revalidated has screening requirements at least as comprehensive and stringent as those for Colorado Medicaid. 8.125.7.F. The Department may deny a Provider’s enrollment or terminate a Provider agreement for failure to comply with screening requirements. 8.125.7.G. The Department may terminate a Provider agreement or deny the Provider's enrollment if the Centers for Medicare and Medicaid Services (CMS) or the Department determines that the provider has falsified any information provided on the application or cannot verify the identity of any provider applicant. 8.125.8 NATIONAL PROVIDER IDENTIFIER FOR ORDERING, PRESCRIBING, REFERRING 8.125.8.A. As a condition of reimbursement, any claim submitted for a service or item that was ordered, referred, or prescribed for a Medicaid member must contain the National Provider Identifier (NPI) of the ordering, prescribing or referring physician or other professional. 8.125.9 VERIFICATION OF PROVIDER LICENSES 8.125.9.A. If a provider is required to possess a license or certification in order to provide services or supplies in the State of Colorado, then that provider must be so licensed as a condition of enrollment as a Medicaid provider. 8.125.9.B. Required licenses must be kept current and active without any current limitations throughout the term of the agreement.

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Page 244

Official source

CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.100 Medical Services Board

244 8.125.7.E. The Department may exempt certain providers from all or part of the screening requirements when certain providers have been screened, approved and enrolled or revalidated: 1. By Medicare, or 2. By another state’s Medicaid program within the last 5 years, provided the Department has determined that the state in which the provider was enrolled or revalidated has screening requirements at least as comprehensive and stringent as those for Colorado Medicaid. 8.125.7.F. The Department may deny a Provider’s enrollment or terminate a Provider agreement for failure to comply with screening requirements. 8.125.7.G. The Department may terminate a Provider agreement or deny the Provider's enrollment if the Centers for Medicare and Medicaid Services (CMS) or the Department determines that the provider has falsified any information provided on the application or cannot verify the identity of any provider applicant. 8.125.8 NATIONAL PROVIDER IDENTIFIER FOR ORDERING, PRESCRIBING, REFERRING 8.125.8.A. As a condition of reimbursement, any claim submitted for a service or item that was ordered, referred, or prescribed for a Medicaid member must contain the National Provider Identifier (NPI) of the ordering, prescribing or referring physician or other professional. 8.125.9 VERIFICATION OF PROVIDER LICENSES 8.125.9.A. If a provider is required to possess a license or certification in order to provide services or supplies in the State of Colorado, then that provider must be so licensed as a condition of enrollment as a Medicaid provider. 8.125.9.B. Required licenses must be kept current and active without any current limitations throughout the term of the agreement.