Become a Provider / PASA

Provider Application Information

In our efforts to standardize our procedures for new providers, we now require that all prospective providers for Imagine! complete an application process. On this page, you will find information to guide you through the application process, including:

• New provider application (Word Doc). Please remit a copy of your resume and references with your application.
• Provider qualifications information. This is general information about qualifications for each type of service available through Imagine!.
• Provider assurances/requirements information. This spreadsheet provides information on how Imagine! will verify an applicant’s ability to provide services through Imagine!. This is provided for your reference only and does not need to be submitted with the application.
• The Imagine! procedures related to the Organized Health Care Delivery System (OHCDS) for Program Approved Service Agencies (PASAs).  Note: PASAs may bill directly for Medicaid reimbursement through Health Care Policy and Financing, through a billing agent, or through Imagine! as an OHCDS.
• Instructions for submitting the provider application.

The Application Process

• To become an independent contractor with Imagine!, fill out a New Provider Application. Please remit a copy of your resume and references with your application.
• To become a Program Approved Service Agency (PASA, Type 2 Provider with Imagine!), please first apply through the Health Facilities and Emergency Medical Services Division (HFEMSD) within the Colorado Department of Public Health and Environment (CDPHE).  You may go here https://www.colorado.gov/pacific/cdphe/program-approved-service-agency-pasa for the application.  You may also contact Certification, Licensing and Records, Health Facilities and Emergency Medical Services Division
  Email: hfemsd-licensingtechsupport@state.co.us
  Email: cdphe.healthfacilities@state.co.us
  Customer Assistance Line: # 303.692.2836
  Monday- Friday, 8:00 am- 5:00 pm
• PASAs that wish to create the OHCDS relationship with Imagine! and who have already been approved by CDPHE as a PASA, should go directly to the New Provider Application. 
• PASAs that will bill directly and who have already been approved by CDPHE as a PASA, should complete the PASA Contact Information Sheet. Instructions for submission are on the sheet.
• To become a Host Home Provider for Innovations, please submit the Host Home Provider Application.
• Once an application has been submitted, it will be routed to the program(s) to which you are applying to provide services. Program managers will initiate a process for verifying qualifications and may arrange for an interview. When this screening process has been completed, Imagine! will begin the process to verify assurances and initiate the contract process with the provider, including collecting information related to provider assurances.

Thank you for your interest in providing services and support through Imagine!. If you have questions or need additional assistance with the application process, please contact Violet Lehman: vlehman@imaginecolorado.org