2015 Provider Contact Information Colorado HealthOP Provider Customer Service: For member eligibility, explanation of benefits, claim status, reconsiderations and plan participation call 866-785-7265. For members needing assistance have them call 866-915-6619. Provider Relations: For credentialing and provider education resources please contact [email protected]. Benefit Determination: call 866-785-7265 To determine if a member is eligible for selected ambulatory procedures and services, prior to rendereing the services please call the number listed above. Pre-Certification/Prior Authorization: For Pre-Certification and Prior Authorization call 888-893-6756 for EPO and 888-893-7264 for PPO. Pre-Certification- Medical necessity determination. This requires judgment or interpretation for benefit coverage. Determination of coverage is based on plan documents, information from the provider, information from nationally recoginzed guidelines. Prior Authorization- This should be done by the patient or provider notifying us that they are going to do something to/with our member. We want to know about this services ahead of time. For a full list of Pre- Certification and Prior Authorization please visit our website at www.cohealthop.org. Formularies: WellDyne- 866-842-4811 Claims: 866-785-7265 Colorado HealthOP P.O. Box 14327 Reading, PA 19612-4327 Attn: Claims Payer ID 49718 5000_MEMB402_ENG_141124_C