Health First Colorado (Colorado's Medicaid Program) Managed Care and CHP+ provider complaint form
This form is used for providers to communicate their complaints about the Medicaid Managed Care Entities (MCEs) and the CHP+ Managed Care Organizations (MCOs) to the Colorado Department of Health Care Policy & Financing. As providers are contracted with MCEs or with CHP+ MCOs, please contact the appropriate health plan to resolve any concerns prior to contacting the Department. 

After the Department receives your completed form, staff will escalate your concern to the appropriate health plan. You should expect to be contacted by the health plan to troubleshoot and resolve outstanding issues.

Please do not include Protected Individual Information (PII) or Protected Health Information (PHI) such as a member's birth date, Health First Colorado ID (Colorado’s Medicaid program), Child Health Plan Plus ID (CHP+), social security number or personal medical information in the form below. 

For more information on what is PHI and PII, please see our page on the Health Insurance Portability and Accountability Act (HIPAA). Visit the Health Insurance Portability and Accountability Act web page at hcpf.colorado.gov/health-insurance-portability-and-accountability-act-hipaa-0.

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Email *
Today's date. *
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Please enter your name (First, Last) *
Please enter the NPI or Medicaid Provider ID of the requestor *
Phone number (optional)
Business Name, include any DBA *
Service Location Address or Business Address (if service location is not applicable) *
Please include the following:  Street, City, State, Zip Code
Preferred method of contact (select all that apply) *
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Alternate contact information (optional)
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