Only those CSM students who participate in the Student Health Benefit Plan (SHBP) are eligible for this plan and must be referred by the the Counseling Center. Referred students will be given a copy of the referral form to present to the provider to verify that the student has been referred and the name of the CSM Counselor.
• Confirmation forms must be completed and submitted to the Counseling Center before the first appointment (unless student is being seen at short notice due to emergency) to insure that actions and claims are processed efficiently.
• All forms must be typed. No handwritten forms will be accepted.
• Forms can be download from this website, completed and sent as attachments through the Student Health Program Secure Messaging System, WordSecure, at https://csm.wordsecure.com/ If you wish to use WordSecure and do not know your login information, please call 303-273-3377. This is the preferred method.
• Forms may also be faxed to 303-384-2009
Please consult your contract for additional obligations and responsibilities that apply.
The SHBP has an annual enrollment. The Plan Year is from the first day of the Fall Semester through the day before the first day of the following Fall Semester. The 2011-2012 Plan Year began August 23, 2011. Please see the Plan Brochure for further information about SHBP elgibility and covered benefits.
In the event a student becomes ineligible for coverage, the Counseling Center will notify the provider.
At the end of a Plan Year, providers who believe that additional visits are medically necessary must submit a new Confirmation/Verification form and a Re-Authorization form for the next Plan Year. THe Counseling Center will re-verify that the student has continued eligibility for services under this Plan, determine if additional visits are medically necessary, and will fax appropriate documents to the provider and the third party administrator. Failure to follow this procedure may result in corrective action and/or disallowed claims.
Verbally confirm that the student was referred under this plan then complete the Confirmation and Verification form prior to the first appointment. No claims will be accepted or paid if this form is not submitted before visits commence.
The Counseling Center will re-verify that the student is eligible for services under this Plan and fax that information to the provider and to Klais and Co., our third party administrator.
Re-authorizations forms are required following the ninth and nineteenth visits, and must be submitted and approved in order for further claims to be paid under this Plan.
Claims are submitted directly, via fax or WordSecure, to Klais and Co. Claim forms can be download from this website. Questions regarding claims processing should be directed to the Counseling Center.