Frequently Asked Questions (FAQs) and Billing Resources

Accounts Receivable and Refunds

How can money be refunded to the Department?

Please note that it is highly recommended to submit electronically which will automatically set up an AR balance.

Checks should be made out to Colorado Department of Health Care Policy & Financing and mailed to:
Gainwell Technologies
P.O. Box 30
Denver, CO 80201

When submitting a paper check, the Refund to Health First Colorado or Returned Warrant Form (located on the Provider Forms web page under the Claim Forms and Attachments drop-down) must be attached.

Each form should only contain the criteria for one claim and the required fields must be filled out on the form. 

How can I obtain a copy of a cashed check?

The following is the charge per warrant requested:
$1.00 per warrant requested

Make checks payable to the Department of Health Care Policy & Financing and mail to: 
Department of Health Care Policy & Financing
Accounting Department
303 E. 17th Avenue
Denver, CO 80203-1714
Both the request and check may be mailed to the address above. Include the following details with the request:

• Billing Provider Number 
• Billing Provider Name 
• Billing Provider Address 
• Contact Name
• Contact Telephone Number 
• Contact Email Address 
• Warrant Number
• Warrant Date 
• Warrant Amount

Multiple warrants on one request are acceptable but include all warrant information for each warrant being requested.

Who do I contact regarding AR balances?

Contact the Provider Services Call Center for information related to AR balances.

What steps should I take when the AR balance is paid in full (there is a canceled check) but a balance still appears on the remittance advice (RA)?

Allow 30 days for processing.
If the AR balance remains after that period, contact the Provider Services Call Center and provide the following information to expedite the request:

• Billing Provider Number
• Billing Provider Name 
• Billing Provider Address 
• Contact Name
• Contact Telephone Number 
• Contact Email Address 
• Check Account Name 
• Check Number
• Check Date 
• Check Amount

If possible, also include RA date in which the receivable was established. 

Electronic Funds Transfer and Paper Check Payment

Do I need to set up EFT?

The Department requires EFT for the following:

• All in-state and border provider groups, clinics and facilities
• Individual providers who are not affiliated with a group, excluding Physician Assistants and Non-Physician Practitioners (RNs)

How do I set up EFT?

Submit an EFT document through the provider enrollment on the Provider Web Portal. Once the update is submitted via the enrollment portal, a specialist will review the submission.

Once the update has been processed by the Department's fiscal agent, an additional two weeks is needed to establish EFT.

Paper checks will be sent until EFT has been established.

Each time bank information changes, a new EFT document must be submitted. 

What steps do I need to take when a check payment is not received or needs to be reissued?

If it has been 30 days since the date of the payment, verify with your bank to ensure the check was not cashed. If not, contact the Provider Services Call Center to see if the check has been cashed.
If the Provider Services Call Center has determined the check has not been cashed, fill out the Affidavit of Lost Warrant Form (located on the Provider Forms web page under the Accounting drop-down) and mail to:

Department of Health Care Policy & Financing 
Accounting Department
303 E. 17th Avenue
Denver, CO 80203-1714

Ask the customer service representative for the warrant number for your reference. Once the signed affidavit is returned, the accounting team will cancel the lost check and reissue in the Colorado interChange system.

Checks may have been returned to the Department's fiscal agent. Providers must update information through the Provider Web Portal.

Appeals

How can a provider submit an appeal?

If all means of achieving satisfactory claim resolution through the fiscal agent and the Claims Processing unit have been exhausted, providers may file a written appeal with the Office of Administrative Courts, at the address listed below.

Appeals submitted to the Office of Administrative Courts must be received within 30 days from the mailing date of the last notice of action.

Office of Administrative Courts
1525 Sherman Street, 4th Floor
Denver, Colorado 80203
Phone: 303-866-2000
FAX: 303-866-5909

Load Letters

Load Letters allow providers to submit claims that are outside the timely filing period (365 days) if the member was retroactively enrolled; however, it is not a guarantee of payment. Providers may submit requests on the Load Letter Request Form (located on the Provider Forms web page under the Claim Forms and Attachments drop-down) and have 60 days from the date of the load letter to submit the claim and attached form for review by the fiscal agent. Upon receiving the request from providers, the Department will generate a Load Letter as long as the request meets all criteria.

If a member was enrolled on the date of service but failed to inform the provider of existing coverage, the provider must obtain that information within 365 days.

For Child Health Plan Plus (CHP+) members, contact the Health Maintenance Organization (HMO) listed on the back of the member’s medical card for a load letter.

All load letter requests should be faxed to the Department at 303-866-2082 or via encrypted email to HCPF_LoadLetterRequests@state.co.us. Use “Load Letter Request” as the subject. Do not use the member's State ID in the subject line.

Timely Filing

What is the deadline for meeting timely filing requirements?

Providers always have at least 365 days from the date of service (DOS) to submit a claim. A timely filing waiver or a previous Internal Control Number (ICN) is required if a claim is submitted beyond the 365-day timely filing period.

What date is used when considering timely filing deadlines?

A claim is considered filed when the fiscal agent documents receipt of the claim.

Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. Phone calls and other correspondence are not proof of timely filing. 

What should providers do if the initial 365-day window for timely filing is expiring?

Providers are required to submit the initial claim within 365 days, even if the result is a denial. Providers must also resubmit claims every 60 days after the initial timely filing period (365 days from the date of service (DOS) to keep the claim within the timely filing period. The previous Internal Control Number (ICN) must be referenced on the claim, even if the claim is over 365 days.

How can a provider qualify for a timely filing waiver (override)?

Claims that are not able to be submitted within the 365-day guideline but have one (1) of the following documents attached to the submission, will be put into suspended status and will be reviewed by the fiscal agent. Attachments should be submitted with the claim via the Provider Web Portal. The fiscal agent does not accept attachments via batch submissions.

• Claims that have been date-stamped by the fiscal agent or the Department and returned to the provider.
• A backdate approval letter (new enrollments, affiliations or updates are not acceptable reasons for late filing). Providers must enroll and submit claims within 365 days from the DOS.
• A load letter for eligibility backdate.

If any of the scenarios listed above apply, but the claim in question is still within the 365-day window, a waiver is not needed, and the provider only needs to resubmit the claim.

Can I attach a copy of my Remittance Advice (RA) as a timely filing waiver for extension?

No. If there is an RA within the last 60 days, providers must reference the previous Internal Control Number (ICN).

What if I contacted the Department or fiscal agent, and I am still waiting for a response?

Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. Phone calls and other correspondence are not proof of timely filing. The claim must be submitted, even if the result is a denial.

A claim is considered filed when the fiscal agent documents receipt of the claim.

What if my enrollment was delayed and that delay took a year?

Providers have 365 days from the date of service to enroll and submit a claim. New enrollments, affiliations or updates are not acceptable reasons for late filing.

What if the issue was with my vendor?

Issues resulting in failure to transmit accurate and acceptable claims, or failure to identify transmission errors in a timely manner, must be addressed. If the issue is between the provider and the software vendor, billing agent or clearinghouse, this does not constitute an acceptable reason to be outside the timely filing period.

What if the member did not notify the provider of eligibility?

Providers are expected to take appropriate and reasonable action to identify Health First Colorado eligibility in a timely manner. Some examples of appropriate action include:

• Reviewing past medical and accounting records for eligibility and billing information for services provided
• Requesting billing information from the referring provider or facility where the member was seen
• Contacting the member by phone or by mail
• Verifying eligibility through the Provider Web Portal

It is not effective to rely solely on billing statements, collection notices or collection agencies as the only means of obtaining eligibility and billing information. If the timely filing period expires because the provider is not aware that the member is Health First Colorado eligible, the fiscal agent is not authorized to override timely filing. The Delayed Notification of Eligibility Form can no longer be used, as providers must submit within 365 days.

Do I need to continue attaching the Explanation of Benefits (EOB) to electronic claims?

Providers who receive payment from Medicare or other insurance/Third Party Liability (TPL) no longer need to attach the EOB to the electronic claim. Providers must include the Medicare or TPL EOB date on the claim. Providers must keep the EOB and supporting documentation on file.

What is the 365-day rule?

Claims with commercial insurance/Third Party Liability must be received within 365 days with no additional extension.

What if Medicare is the primary payer, and they processed the claim after the 365 days expired?

Providers have an additional 120 days from a Medicare payment or denial and must include the Medicare EOB date on the claim.

Does the 365-day timely filing period apply to claims submitted through DentaQuest and Magellan?

The timely filing extension to 365 days does not apply to pharmacy (point of sale) claims submitted through Magellan. However, Durable Medical Equipment (DME) claims are subject to the updated 365-day timely filing policy. DentaQuest claims are subject to the 365-day timely filing policy.

How does timely filing apply to adjustments and voids?

If a claim is an adjustment, and the provider is returning money, or if the provider is requesting an adjustment that does not change the reimbursement amount, timely filing does not apply. However, if the claim is an adjustment to request additional reimbursement, timely filing does apply.

If my claim is over 365 days, do I need to submit on paper with documentation?

No. All claims, even those with attachments, should be submitted via the Provider Web Portal.

If I don’t meet any of the above requirements, should I submit a reconsideration?

No. Submitting a reconsideration without a previous ICN or acceptable documentation will result in a denial.

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