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. Inpatient/Outpatient Hospital Revisions Log.Outpatient Hospital with NDC Claim Example.Inpatient Hospital Part A Claim Example.Outpatient Hospital Crossover Claim Example.Outpatient Hospital Lab and X-Ray Claim Example.Inpatient for Combined Stay Under 48-Hour Readmission Policy Claim Example.Sterilization, Hysterectomies, and Abortions.Observation Billing for Outpatient Claims.Outpatient Hospital Unbundled DME Billing.Outpatient Hospital Specialty Drug Carveout.EAPG Consolidation and Distinct Procedures.Recurring Visits and ED/Observation Billing for Outpatient Claims.Enhanced Ambulatory Patient Grouping System (EAPG).Inpatient Subacute Care during the COVID-19 Public Health Emergency.Other Provider Preventable Conditions (OPPC) - FY2013."Present on Admission" Indicator on Hospital Claims.Hospital Service Payments - Inpatient Reimbursement.Billing for Substance Use Disorder (SUD) Services Rehabilitation for Alcohol and Drug Dependence.Obtaining Authorization for Psychiatric/Psychological Services.Billing for Psychiatric Hospital Inpatient Services - non-SUD.Billing for Dates of Service that Span the Fiscal Year for Long Term Acute Care Hospitals, Rehabilitation Hospitals and Spine/Brain Injury Treatment Specialty Hospital.Spine/Brain Injury Treatment Specialty Hospital. Long-Term Care and Rehabilitation Services.Billing for Combined Stays under the 48-hr Readmission Policy.Out-of-State Inpatient Hospital Services.Medicaid and Criminal Justice Involved Populations.Medicare Part B only/Part A Exhaust Coverage.Billing for Immediate Post-Partum Long-Acting Reversible Contraceptives (IPP-LARCs).Newborn Hearing and Metabolic Screenings.Billing for Services Rendered in a Distinct Part Unit. Interim Payments for DRG Hospitals with Long-Term Inpatient Stays.Inpatient/Outpatient Hospital Billing Information.Inpatient Hospital Review Program (IHRP).Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).General Prior Authorization Requirements.
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