Register accreditation information here to receive Colorado Medicaid reimbursement for Diabetes Self-Management Education Services.

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* 1. What is the name of the accredited provider as it appears on the accreditation?

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* 2.

Type in the Medicaid ID/Provider ID of the accredited provider.

If the accreditation covers more than one Medicaid ID/Provider ID, a separate form must be completed for each ID.

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* 3.

Type in the NPI of the accredited provider.

If the accreditation covers more than one NPI #, a separate form must be completed for each NPI #.

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* 4. Which organization accredits or recognizes the Diabetes Self-Management Education program for this accredited provider?

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* 5. Please provide the date of the most recent accreditation or recognition.

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* 6. Please provide an email address.

Please note:  you will receive an email confirmation within one month of submission.  If you have any questions, please email meghan.delisle@state.co.us

 

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