Third Party Liability and Recoveries

Health First Colorado (Colorado's Medicaid program) is the payer of last resort when a member has other insurance or Medicare. Federal regulations require that all available resources be used before Health First Colorado considers payment. This means that if a member is able to provide for their care, the member must pay for medical benefits first. If there is a responsible third-party who should be paying for the member's health benefits -- for example, a health insurance provider -- that responsible third-party should be paying first. Coordinating benefits makes sure that the correct party pays first by, 1) cost-avoiding claims where a known other party should be paying, or 2) cost-recovering from a claim Health First Colorado paid that should have been paid by someone else.

First Party Cost Avoidance

  • Trust Review
  • Resource Review
  • Transfers Without Fair Consideration

Third Party Cost Avoidance

Third Party Insurance

Federal law requires that Health First Colorado be the "Payer of Last Resort." Health First Colorado will not pay for health care services until a third party insurer has paid its share first.
Contact: Pete Garcia: 303-866-5701 / Pete.Garcia@state.co.us

Non-Custodial Parent Medical Support

Health First Colorado will collect costs from noncustodial parents who have medical support orders but do not have affordable employer sponsored health insurance coverage available or are unable find affordable health care coverage.
Contact: Pete Garcia: 303-866-5701 / Pete.Garcia@state.co.us

Third Party Cost Recovery

Additional Information

  • A member's commercial insurance, as opposed to an insurance policy belonging to an at-fault party, must be billed first. The Colorado Medical Assistance Program is always the payer of last resort.
  • Lower of Pricing is used to calculate reimbursement.
  • If a member is not insured by a commercial insurance company, bill the Colorado Medical Assistance Program.
  • A provider may not bill the member for the difference, nor place a lien for medical assistance against the member's right to recover against at-fault parties, or bill the at-fault party's insurance