Statutes, codes, and regulations
Colorado Administrative Code
Department 2505 - Department of Health Care Policy and FinancingDivision 2505 - Medical Services Board (Volume 8; Medical Assistance, Children's Health Plan)Rule 10 CCR 2505-10-8.100 - MEDICAL ASSISTANCE - SECTION 8.100Section 10 CCR 2505-10-8.130 - PROVIDER PARTICIPATION
Section 10 CCR 2505-10-8.130.3 - ADVANCE DIRECTIVES
Section 10 CCR 2505-10-8.130.60 - PROVIDERS ARE RESPONSIBLE FOR ALL CLAIMS SUBMITTED

10 Colo. Code Regs. § 2505-10-8.130.60

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Current through Register Vol. 47, No. 11, June 10, 2024
Section 10 CCR 2505-10-8.130.60 - PROVIDERS ARE RESPONSIBLE FOR ALL CLAIMS SUBMITTED
A. A Provider shall accept full legal responsibility for all claims submitted under the Provider's Medical Assistance Program ID number to the Medical Assistance Program, whether submitted by the Provider or submitted on the Provider's behalf.
1. A Provider shall comply with all federal and state civil and criminal statutes, regulations, and rules relating to the delivery of goods and services to eligible individuals, and to the submission of claims for such goods and services. A Provider's non-compliance may result in no payment for goods and services rendered.
B. A Provider shall furnish to the Department its National Provider Identifier (NPI) (if eligible for an NPI) and include the NPI on all claims submitted pursuant to Sections 8.125.8 and 8.126.3.
C. A Provider shall request payment only for those goods and services which are medically necessary, as such term is defined in Section 8.076.1.8. and in any other subsection of these rules defining medical necessity, and which are rendered personally by the Provider or rendered by qualified personnel under the Provider's direct and personal supervision.
1. A Provider shall submit claims only for those goods and services provided by health care personnel who meet the professional qualifications established by the State.
2. Any misrepresentation or falsification of a claim submitted by a Provider, or on a Provider's behalf, may subject the Provider to fines and/or imprisonment under state or federal law.
D. If at any time the Department determines that a Provider has failed to maintain compliance with any state or federal laws, rules, or regulations, the Provider may be suspended from participation in the Medical Assistance Program, and may be subject to administrative actions authorized by federal or state law or regulation, criminal investigation, and/or prosecution.

10 CCR 2505-10-8.130.60

44 CR 23, December 10, 2021, effective 1/10/2022