Skip to main content
Home
  • Home
  • For Our Members
  • For Our Providers
  • For Our Stakeholders
  • About Us
1
  1. Home
  2. For Our Providers
  3. Provider Services
  4. Provider Forms
  5. Federally Qualified Health Center Forms

Federally Qualified Health Center Forms

Cost Reports

  • Cost Report Instructions
  • Cost Report Forms
  • Payment Methodology Agreement Form
  • Pharmacy Overhead Allocation Form

ACC PMPM Appendix

  • FQHC ACC PMPM Appendix 2020

Scope-of-Service Rate Adjustments

  • Scope-of-Service Rate Adjustment Instructions
  • Scope-of-Service Rate Adjustment Application

Alternative Payment Methodology 2

  • Alternative Payment Methodology 2 Billing Guidance

Managed Care Accuracy Audit Reports - for FQHCs

  • MCAAR FQHC Instructions
  • MCAAR FQHC Data Section
  • MCAAR FQHC Attestation Statement

Managed Care Accuracy Audit Reports - for MCEs

  • MCAAR MCE Instructions
  • MCAAR MCE Data Section
  • MCAAR MCE Attestation Statement

 

#FFFFFF

  • Privacy Practices
  • Nondiscrimination
  • Americans with Disabilities Act
  • Accessibility Statement
  • Website Feedback
  • Contact Us

Member Contact Center
1-800-221-3943 / State Relay: 711

Our Mission

Improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

  • Department Performance Plan
  • Health Equity

HCPF Social Media

Twitter logo LinkedIn logo Facebook logo
 

Translate This Page

 

placeholder

  • © 2023 State of Colorado
  • Transparency Online
  • Support
Colorado Official State Web Portal