1. Thank you for accessing Friday Health Plans’ provider training
Thank you for accessing Friday Health Plans’ provider training. We understand time is valuable, so we’ll only take a few minutes here to hit the highlights.

2. WELCOME TO FRIDAY HEALTH PLANS
Recently acquired Colorado Choice Health Plans
Headquarters in Denver, operations in Alamosa, CO
Simple plan designs
New in Denver, Durango individual market
Continue serving rural areas and Co. Springs
First of all, we want to welcome you and thank you for partnering with Friday Health Plans (FHP). Some may be thinking we’re a new insurance company, but that’s not the case. We were formerly known as Colorado Choice Health Plans and have over 40 years of history in serving the rural communities of Colorado. FHP acquired Colorado Choice in late 2017 and the name change became official in January, While headquarters are now located in Denver, operations remain in Alamosa, CO. We’re pleased to now offer simple plan designs and new individual markets in Denver and Durango. Of course, we’ll continue our excellent service in rural Colorado and Colorado Springs, as well.

3. You can see here the counties we serve.

4. Member Identification
Call Customer Service at (800) to verify eligibility OR
login to the Friday Health Plans Portal
and click on the provider portal link in the upper right corner
Possession of the ID card does not guarantee eligibility of coverage. Provider must verify prior to services being rendered for non-urgent or emergent.
One of the first questions we receive is regarding Member Identification. To verify member eligibility please call our Customer Service team or login to the provider portal, Health Trio. Next, we’ll show some examples of ID cards, but please remember the ID card does not guarantee eligibility of coverage.

5. ID Card Samples
To identify group members, look for SG or LG as part of the group number on the ID card
To identify individual members, look for ID as part
of the ID card number
Note on the ID cards that SG or LG identify group members, and ID identifies individual members.
*Individual Members do not have access to the UC Health System

6. ID Card Samples - Continued
To identify Denver Metro members, look for the DV at the bottom middle of the ID Card
Here we have a Denver Metro member card. These members are part of a limited network and are identified by a DV on the bottom of the card.
*Denver Metro members are part of a limited network. They only have access to SCL Health and Hospitals, National Jewish, Children’s Hospital and a limited number of specialists/PCPs.

7. Preauthorization/Referrals
If a Specialist will be performing any procedures, they must request authorization by submitting referral directly to Friday
Utilization Management review is required and documentation may be requested.
Request for Authorization Form
Non-Covered Services, Notification & Preauthorization List
*Hospital observation over 23 hours is considered inpatient.
Preauthorization is extremely important and additional information may be requested. You’ll want to familiarize yourself with our request for authorization form and the list of services requiring notification or preauthorization. Non-Covered Services are also listed there.

8. Pharmacy Management Program
Four-tier co-payment structure
VRx (Magellan), specialty drugs through Archimedes
Formulary available online
Friday Health Plans Formulary
Prior Authorization may be required
Our pharmacy management program may require prior auth as well, and the formulary is available online.

9. Paper Claim Submission
To submit paper claims: Friday Health Plans Attn: Claims 700 Main St #100 Alamosa, CO OR Fax to (719) Claims must be on a HCFA1500 or UB-04 with ICD-10 codes
Paper claims are accepted by mail or fax and must be on the forms mentioned here.

10. Electronic Claim Submission
Clearinghouses used:
ClaimRemedi
CortexEDI
GE Healthcare
Infinedi
InsightEDI
RelayHealth
ViaTrack
Zotec
Friday Health Plans Payer ID – H0657
We also accept electronic claims. Our list of clearinghouses is continually growing and changing, so don’t hesitate to inquire with us if you don’t see your clearinghouse listed here.

11. Credentialing & Recredentialing
All providers must be credentialed with Friday Health Plans prior to rendering services to members.
To initiate the credentialing process on a new provider, submit the Provider Change Request Form
Ancillary and Facility Providers must complete the Ancillary/Facility Credentialing Application
*Providers that do not utilize CAQH must submit the
Colorado Health Care Professional Credentials Application
Credentialing is an important facet of our URAC accreditation and is required for all providers before services are rendered. Please be sure to notify us by submitting the provider change request form any time a provider is termed or added to your group. Keep in mind the credentialing process can take 4-6 weeks and we’re unable to backdate.

12. Provider Relations Personalized training as needed, upon request
Contracting
Fee schedule questions
Authorization issues that involve medical management
Credentialing and recredentialing
Member and physician relationships
Provider Manual requests
Demographic Changes
Provider additions/updates
Our Provider Relations department is here for you and just a call or away. Please get in touch with any questions about contracting, credentialing, or the other issues listed here.

13. Customer Service/Operations Team
(800) or (719)
Member eligibility
Claims issues (timely filing, adjudication, EOB, RAs, check/refund/recoupment issues)
Authorization requirements
Benefit and member questions
Provider dispute resolution assistance
Network inquiries
Referral and authorization status
Provider network
Formulary questions
Our Customer Service representatives are some of the best in the business. They’re happy to assist with questions about member eligibility, claims, authorizations, and more.

14. Additional Provider Resources
Please visit for more information. You can download the provider manual, current forms and learn more about the plans we offer. Provider Relations Contacts: Ashley Palmer – Carrie Howard – Credentialing Contact: Rita Naranjo – Phone:
This concludes our Provider Training. Please take a moment to visit our website at You’ll find useful information there, including the Provider Manual, forms, and more about the plans we offer. Again, please don’t hesitate to get in touch with us with any questions or concerns. We appreciate all you do for our members and are anxious to assist you in any way we can.