House Bill 25-1033, titled "Medicaid Third-Party Liability Payments," was introduced on January 8, 2025, and has passed the House with a vote of 55 in favor, 7 against, and 2 excused.
Key Provisions:
Third-Party Payer Reimbursement:
The bill mandates that third-party payers reimburse the Department of Health Care Policy and Financing (HCPF) for healthcare items and services provided to Medicaid members, regardless of prior authorization requirements.
Response Time for Claims:
Third-party payers are required to respond to HCPF's inquiry regarding a claim for payment within 60 days of receipt. The response must be either payment of the claim or a written denial.
This legislation aligns Colorado's Medicaid statutes with recent federal law changes, aiming to streamline the reimbursement process and ensure timely responses from third-party payers.
Summary
The bill requires third-party payers to reimburse the department of
health care policy and financing (state department) for health-care items and services rendered to a medicaid member regardless of whether prior authorization was obtained.
The bill requires third-party payers to respond to the state
department's inquiry regarding a claim for payment no later than 60 days after receiving the state department's inquiry. The third party must respond either by paying the claim or issuing a written denial of the claim to the state department.
