1

provider self disclosure test

  1. Fill out this spreadsheet and save to your computer
  2. Fill out and submit this Form and attach the spreadsheet from step 1
  3. Once submitted, the process is complete

Did you know that providers have an obligation to ensure that claims submitted to HCPF 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 Medical Assistance programs

Claims which are found to be inconsistent with billing practices and policies are subject to recovery. If a provider believes they have violated policies or inappropriately billed for services, they may self-audit and disclose the improper payments to HCPF. (Disclaimer: HCPF assumes a provider has waived the right to an informal reconsideration and administrative appeal when submitting a self-disclosure)

Provider self-disclosure steps

Providers WITH a Google account

  1. Fill out this spreadsheet and save to your computer
  2. Fill out and submit this Form and attach the spreadsheet from step 1
  3. Once submitted, the process is complete

Providers WITHOUT a Google account

  1. Fill out this spreadsheet and save to your computer
  2. Fill out and submit this form (do not attach a spreadsheet to this form)
  3. Email the HCPF Self-Disclosure team, attaching the spreadsheet from step 1
  4. Once emailed, the process is complete

You may also mail the printed form and spreadsheet to the Department at:

HCPF PICO
PO Box 5143
Denver, CO  80217

In the event you are unable to submit the required documents, or have additional questions, email the Provider Self-Disclosure team.