Health First Colorado – Incorrect Member Billing

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). Visit 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. Review the Policy Statement: Billing Health First Colorado Members for Services web page for more information.

Source: https://www.colorado.gov/pacific/sites/default/files/Bulletin 0321_B2100460.pdf