Colorado Recovery Audit Contractor (RAC) Program

About the Colorado RAC Program

RAC Program Purpose

Under Section 6411(a) of the Affordable Care Act, each state must contract with a contingency-fee-based vendor to review provider claims. The purpose of the review is to reduce improper Health First Colorado (Colorado's Medicaid program) payments through the efficient detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments. See also CRS Section 25.5-4-301 and 10 CCR 2505-10, Sections 8.050 and 8.076.

In November 2009, President Barack Obama signed Executive Order 13520 which aimed at reducing improper payments by increasing transparency in government and holding agencies accountable for reducing improper payments. A year later, Section 6411 of the Affordable Care Act was enacted, directing each state Medicaid program to establish a program in which it contracts with one or more recovery audit contractors for the purpose of identifying underpayments and overpayments and recouping overpayments.

The purpose of the RAC is to reduce improper payments while also presenting billing education opportunities to providers to improve the accuracy of claims submitted to the Department for reimbursement. Under the RAC, all provider types will be audited. The RAC vendor will audit the following types of claims: Health First Colorado fee-for-service, waiver services, managed care, and Child Health Plan Plus (CHP+) claims. HMS will conduct post-payment claims reviews of provider-submitted Health First Colorado paid claims to determine whether services were actually provided, medically necessary, coded correctly, and properly paid or denied.


Covered services and Health First Colorado benefits are defined throughout the Code of Colorado Regulations (CCR). Overpayments are defined under 10 CCR 2505-10 section 8.076.9 which states "Overpayment means the amount paid to a Provider which is in excess of the amount that is allowable for goods or services furnished under Section 1902 of the Social Security Act and which is required to be refunded under Section 1903 of the Act." Any claims for which documentation is not received upon request shall be deemed to be overpayments subject to recovery regardless of whether or not services were provided. The Department will recover the overpayments, per 10 CCR 2505-10 8.040. Providers are required by Section 1902(a)(27) of the Social Security Act and 10 CCR 2505-10, Section 8.130 to:

  • Retain records necessary to disclose the nature and extent of services provided to recipients.
  • Maintain records that fully substantiate or verify claims submitted for payment.
  • Submit records to federal and state governments upon request.


Underpayments which are discovered by the Colorado RAC are reported to policy and the claims system vendor to adjust any and all claims with specified underpayments to correct via a system mass adjustment. Providers who believe they have been underpaid for services can reach out to the Provider Services Call Center for information on how to correct their claims.

Refer to the Copy, Adjust, or Void a Claim Quick Guide for more information.

The Colorado RAC Vendor

In 2021, the Department awarded Health Management Systems, Inc. (HMS) the contract to act as its Recovery Audit Contractor (RAC). HMS serves as a RAC vendor in several other states around the nation.

Meet the Colorado RAC Team

Coming soon

RAC & Medicaid Rules, Laws, & Regulations

Reports and Scorecards

Colorado RAC Reports

Coming soon

Department Reports

CMS Reports

HCFA Rulings
Coming soon
RAC Resources

Government Accountability Office Reports

Office of Inspector General Reports

Fraud Alerts
Coming soon
Reports and Recommendations
Coming soon

Medicaid Fraud Control Unit (MFCU) Reports

Civil Case Reports
Coming soon
Criminal Case Reports
Coming soon
Corporate Integrity Agreements
Coming soon

National RAC State Program Links and Resources

Coming soon

Online Provider Training and Resources

RAC 101 And General Provider Training

HMS Training Resources

More coming soon

Department Training Resources

More coming soon

Provider Type-Specific Training 
Coming soon

Colorado RAC Stakeholder Engagement

Upcoming Meetings and Documents

May 12, 2023 Stakeholder Meeting
August 3, 2023 Stakeholder Meeting

Provider Requests and Surveys

RAC Provider Stakeholder Engagement (Questions, Comments & Suggestions) Form
This form is utilized by the Department to identify Common & Trending:
  • Complaints & Suggestions
  • Areas to build training content for
  • Agenda items for the next stakeholder meeting
Use the Questions, Comments & Suggestions Form to provide feedback.
Provider Request to Participate in RAC Advisory Board Form

This form is utilized by providers to request to be on the Colorado RAC Advisory Board & to upload their CVs/resumes. 

Use the Colorado RAC Provider Advisory Board Member Consideration Form to be considered for the board.

Provider Request to Participate in the Inpatient Rebilling System Testing Pilot

This form is utilized by Providers to request to take part in testing the Claims system after rebilling programming has been completed. 

The Providers will meet with the Department to identify common issues, recommendations, and to rebill “Level of Care” RAC Audit findings from an inpatient to outpatient claim. They will give recommendations and help build processes to ensure that the rebilling is efficient and works for the Providers.

Use the Colorado RAC Re-billing Pilot Provider Requests for Participation Form to be considered for the pilot.

Provider Request To Be Added To The Department's RAC Email Contact List

This form is utilized by the Department to send email blasts, flyers, and any communications to Providers. This will ensure quick and efficient information is being communicated while any updates to the website or content are being made.  

Use the Colorado RAC Stakeholder Contact List Request Form to receive emails blasts and information about the RAC Program.

Stakeholder Communications

Email Blasts
Audit Communications
Coming soon
RAC Program Updates
Coming soon
Bulletins & Publications
Coming soon

Provider Advisory Board

Coming Soon

Contact Information

Department Recovery Audit Contract Section

Email hcpf_corachcpf@state.co.us for requests related to:

  • Payment Plans
  • Offset Requests
  • Financial Questions

Emails for specific requests will be updated in the next 3-6 months with an email blast sent. The website will be updated once the information is received.

Health Management Systems (HMS) Contacts

HMS Colorado RAC Provider Services Team

Call (877) 640-3419, available M-F 8:00 a.m. to 5 p.m. (MST) for requests related to:

  • Exit Conference Requests
  • HMS Colorado RAC Provider Portal Questions
  • Address Updates in the HMS RAC Provider Portal
  • Claim/Review Status (Audit) Questions

Email CORAC@HMS.com for requests related to:

  • Providing a Password for a CD or DVD
  • HMS Escalations
HMS Mailing Addresses
(if you are not using the HMS Colorado RAC Provider Portal to upload documents electronically) 
Medical Records Submission Informal Reconsideration Request Submission
HMS – Colorado Recovery Audit Services
5615 High Point Drive
Mail Stop 200-CO
Irving, TX 75038
HMS – Colorado Recovery Audit Services
Informal Reconsideration Request
5615 High Point Drive
Stop 200-CO
Irving, TX 75038


For questions about HMS letters regarding commercial or other coverage, call HMS Third-Party-Liability (TPL) Provider Relations at 1-877-262-7396.