This form will be used for providers to report their complaints about the Medicaid Managed Care Entities (MCEs) to the Colorado Department of Health Care Policy & Financing. As providers are contracted with individual MCEs, please contact your MCE to try and resolve any concerns prior to contacting the Department. After the Department receives your completed form, staff will escalate your concern to the appropriate MCE. You should expect to be contacted by the MCE to help troubleshoot and resolve outstanding issues.

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