info@mdrevenuegroup.com9:00 AM - 5:00 PM | Mon - Fri
Health First Colorado links members with a Primary Care Medical Provider (PCMP) and one of seven Regional Accountable Entities (RAEs). The RAEs manage behavioral health capitation and coordinate physical health integration. Practices must accurately link PCMP attribution numbers to capture value-based incentive pool distributions.
Colorado’s out-of-network balance billing statute (HB 19-1174) took effect in 2020, establishing state-specific payment benchmarks and mediation processes for out-of-network emergency and non-emergency services at in-network facilities. Billing teams must determine whether a plan is state-regulated or self-funded (ERISA) to choose the correct arbitration track.
Novitas Solutions administers Medicare in Colorado under Jurisdiction H. Novitas actively audits medical necessity for spinal interventions, advanced diagnostic imaging, and hyperbaric oxygen therapy. Documentation must align with JH Local Coverage Determinations (LCDs) to withstand prepayment probe reviews.
UCHealth (University of Colorado Health), CommonSpirit Health (Centura), Intermountain Health (formerly SCL Health), and Denver Health dominate hospital services. Commercial payer contracts and referral directories are tightly integrated with these health systems, requiring aligned specialist credentialing.
Precision claims submission designed for Health First Colorado RAEs, Novitas JH Medicare, and commercial Front Range payers.
Learn MoreFull-cycle RCM managing prior authorizations, HB 19-1174 arbitration filings, and PCMP quality measure captures.
Learn MoreProvider enrollment across Anthem BCBS, Kaiser Permanente, Health First Colorado RAEs, and regional hospital networks.
Learn MoreComprehensive audit analyzing Colorado Option payment parity, uncollected out-of-network balances, and Novitas JH compliance.
Learn MoreFront-desk intake and prior authorization coordinators experienced with Colorado commercial and RAE Medicaid portals.
Learn MoreBenchmark clinical collection speed against Colorado regional denial patterns and commercial fee schedule shifts.
Learn MoreLocal search engine visibility for independent practices competing with UCHealth, CommonSpirit, and Intermountain in Denver and Colorado Springs.
Learn More| Colorado Payer Reality | The Generic Billing Trap | The MD Revenue Group Approach |
|---|---|---|
| Health First Colorado RAEs | Failing to link PCMP attribution numbers to the regional RAE, losing value-based quality pool distributions. | We configure EHR systems to capture required CPT-II quality metrics and track regional RAE capitation reconciliations. |
| HB 19-1174 Surprise Billing | Submitting state-regulated commercial out-of-network claims to the federal NSA portal instead of state arbitration. | We audit plan ID cards for the CO-DOI designation and file state-mandated arbitration within strict 30-day windows. |
| Novitas JH Medicare LCDs | Applying national Medicare standards without verifying Jurisdiction H Local Coverage Determinations for outpatient procedures. | We audit medical necessity documentation against Novitas JH LCDs for interventional injections and outpatient surgery. |
| Colorado Option Standard Plans | Absorbing commercial fee schedule compression without tightening clean-claim velocity and denial appeals. | We accelerate first-pass clean claim throughput (targeting 98%+) to maximize collection yield under standardized plans. |
We audit 90 days of claims for Health First Colorado RAE alignment and Novitas JH LCD compliance.
We connect clearinghouse and EDI gateways with Novitas JH, Health First Colorado, and commercial payers without interruption.
Real-time visibility into clean claims rate (targeting 98%+), A/R days under 32, and recovered revenue.
Our Colorado billing specialists recovered out-of-network surgical balances via HB 19-1174 state arbitration, resolved RAE attribution leaks, and streamlined Novitas JH claim submissions.
See What We Can Recover For YouColorado HCPF is advancing Phase III of the Accountable Care Collaborative, updating RAE contract standards, expanding pediatric behavioral integration, and standardizing alternative payment models.
Providers must review plan insurance cards to verify whether out-of-network claims fall under Colorado Division of Insurance mediation rules or the federal No Surprises Act portal.
Novitas JH has intensified pre-payment probe audits on facet joint interventions, epidural steroid injections, and outpatient arthroscopy across Colorado provider groups.
We audit specifically for Health First RAE attribution leaks, HB 19-1174 arbitration recoveries, and Novitas Jurisdiction H local schedules.
