2505-10) for specific information when providing hospital care. Providers should refer to the Code of Colorado Regulations, Program Rules (10 C.C.R. Therefore, the information in this manual is subject to change, and the manual is updated as new billing information is implemented. The Department of Health Care Policy and Financing (the Department) periodically modifies billing information. Non-emergency outpatient services are subject to Primary Care Physician Program guidelines. Inpatient/Outpatient Hospital Billing Informationīoth inpatient and outpatient hospital services are a benefit of Health First Colorado when medically necessary and supervised by a physician. Professional claims (CMS 1500) associated with the admission may need authorization separately depending on the service.įor information regarding the PAR program including policy and How-to Guides please visit the Colorado PAR web page.įor information regarding Inpatient Hospital Review Program, visit the IHRP 2.0 web page. This authorization is for the institutional claim (UB-04). The IHRP requires that some inpatient hospital admissions be authorized through the ColoradoPAR program. More information can be found on the Department's Provider Contact web page.īack to Top Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)įor Gender Affirming Care Services, please refer to the Gender Affirming Care billing manual. Please consult the General Provider Information Manual on the Department's Billing Manual web page for information about Prior Authorization requirements. Prior Authorization Requests (PARs) must be submitted via the ColoradoPAR program. Refer to the General Provider Information manual for general billing information.
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