Become a Provider

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. This is a Word document that must be saved (to your computer) to complete and then emailed to Imagine!.  Email attachment is the preferred method to submit the application but if you are not able to email the completed application you may fax or mail it to Laura Chatman at Imagine!.
  • 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, may bill through a billing agent, or may bill through Imagine! as an OHCDS.
  • Instructions for submitting the provider application.

The Application Process

  • PASAs that will be billing directly and who have already been approved by CDPHE as a PASA, should complete the PASA Contact Information Sheet below. Instructions for submission are on the sheet.

 

    Please note:  Alternate application processes
  • If you are applying to become a NEW:

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.

 

 

Informational and Reference Documents

  • Click Here for Provider Qualifications Information

  • Click Here for Steps to become a Service Provider for ASD or BCI

  • Click Here for Provider Assurances/Requirements Information

  • Click Here for PASA Contact Information Sheet (for non--OHCDS)



New Provider Application

  • Click Here for New Provider Application - Instructions for submitting the New Provider Application are in the gray box below.

 

INSTRUCTIONS FOR SUBMITTING THE PROVIDER APPLICATION

TO SUBMIT YOUR APPLICATION BY EMAIL:
(This is the preferred method. Please submit in this way if you possibly can.)

  1. Fill out the New Provider Application.
  2. Save it to your computer (your Desktop is fine, or any folder in which you will be able to find it easily)
  3. Then click here to open an email, or open the email program of your choosing and use this email address: lchatman@imaginecolorado.org.  For prompt attention, please enter IMAGINE PROVIDER APPLICATION in the subject line of your email.
  4. Attach the completed document that you saved to your computer to the email (and also a copy of your resume or CV), then send.

TO SUBMIT YOUR APPLICATION BY FAX:

  1. Print out your completed New Provider Application.
  2. Fax it to (303) 665-2648, Attention Laura Chatman.

TO SUBMIT YOUR APPLICATION BY MAIL:

  1. Print out your completed New Provider Application.
  2. Mail to 1400 Dixon Ave., Lafayette, CO, 80026, Attention Laura Chatman.

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. Payment for any services cannot be made until all requirements for the contract have been satisfied.

Thank you for your interest in providing services and supports through Imagine!. If you have questions or need additional assistance with the application process, please contact Laura Chatman: lchatman@imaginecolorado.org.

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