10 Colo. Code Regs. § 2505-10-8.7407

Current through Register Vol. 47, No. 24, December 25, 2024
Section 10 CCR 2505-10-8.7407 - HCBS Provider Agency Billing
A. Claims for HCBS services are payable only if submitted in accordance with the following procedures:
1. Provider Agencies shall verify Member eligibility prior to delivering services;
2. Provider Agencies shall verify a Prior Authorization Request (PAR) has been approved for the services in question, prior to service provision and claim submission;
3. Claims shall be submitted to the Fiscal Agent in accordance with Department billing manuals and policies, outlined in Section 8.043;
4. Claims shall only be submitted for services the Provider Agency is enrolled to provide, including correct HCBS specialties;
5. Claims shall only be submitted for services provided in accordance with all applicable federal and state statutes, regulations, and other authorities;
6. Submitted claims shall include all data elements required to complete the National Uniform Claim Committee Form 1500 (CMS 1500).
B. Payment shall not exceed rate shown in the Health First Colorado Fee Schedule in effect on the date services are provided.
C. Pursuant to § 25.5-4-301, C.R.S., Provider Agencies shall not collect copayments or seek reimbursement from eligible Members for covered services.

10 CCR 2505-10-8.7407

47 CR 03, February 10, 2024, effective 3/16/2024
47 CR 21, November 10, 2024, effective 11/30/2024