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INCORRECT HEALTH FIRST COLORADO MEMBER BILLING
From Colorado Department of Health Care Policy & Financing
Health First Colorado members cannot be billed for services covered by Health First Colorado.
Providers cannot bill members in the following circumstances:
Third-Party Liability (TPL) co-pays and deductibles – Providers cannot bill members
for the difference between commercial health insurance payments and the billed
charges when Health First Colorado does not make additional payment. The provider
also cannot bill members for co-pay or deductibles assessed by Third-Party Liability
(TPL) (commercial insurance). Refer to the General Provider Information Manual for more
information.
Delayed Notification of Eligibility from the member - Providers must verify eligibility
within a timely manner.
Claim denials - Timely filing, place of service invalid, contract invalid, or other
denials for the line item or the entire claim are not valid reasons to bill the member.
Provider is not enrolled with Health First Colorado - Once the services have been
rendered to the member, the provider must enroll with Health First Colorado in order
to receive payment. The provider may not bill the member if they choose to not
enroll.
Providers shall not send overdue Health First Colorado member accounts to collection
agencies unless the billing is for a non-covered service and the member has reneged on a
written payment agreement.
Visit the Policy Statement: Billing Health First Colorado Members for Services web page for more information.
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