Provider Self-Disclosure

A provider has an obligation to ensure that claims submitted to the Department of Health Care Policy & Financing (Department) are proper. Section 1128J(d) of the Social Security Act requires providers to report and return overpayments to the Department within 60 days from the date the overpayment is identified. Issues appropriate for disclosure may include, but are not limited to:

  • Billing errors,
  • Systemic errors, and
  • Violations of state and federal laws and regulations relating to the Medical Assistance programs

To report a self-disclosure, please complete the self-disclosure spreadsheet or provide the Department with a report in Microsoft Word or Excel and include the following information:

  • Provider Name,
  • Provider National Provider Identification (NPI),
  • Provider Medicaid Identification Number:
  • Provider contact information (name, phone number, address and email address),
  • A full description of the matter being disclosed including time covered, 
  • Claims affected for each Service Location
    • Service Location Number
    • Service Location NPI
    • Client Medicaid Identification Number
    • Client First and Last Name
    • Date of Service
    • Procedure Code, if applicable
    • Revenue Code, if applicable
    • Prescription Number, if a pharmacy claim
    • Overpayment Amount
    • TCN/ICN, if applicable

The Self-Disclosure or Self-Audit letter, a copy of the payment and the claims spreadsheet in Excel format shall be sent by encrypted email to:  eileen.sandoval@state.co.us

Submit payment with a copy of your self-disclosure letter to:

HCPF PICO
PO Box 5143
Denver, CO  80217

In the event you are unable to email the required documents, please contact Eileen Sandoval by email for further instructions.

Disclaimer: The Department assumes a provider has waived the right to an informal reconsideration and administrative appeal when submitting a self-disclosure.