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Legislative Year: 2023 Change

Bill Detail: HB23-1295

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Title Audits Of Department Of Health Care Policy And Financing Payments To Providers
Status Governor Signed (06/01/2023)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors R. Bockenfeld (R)
S. Bird (D)
Senate Sponsors R. Zenzinger (D)
B. Kirkmeyer (R)
House Committee Appropriations
Senate Committee Appropriations
Date Introduced 04/17/2023

Joint Budget Committee. The bill makes the following changes
to the reviews and audits of the payments by the department of health care
policy and financing (department) to providers:
  • The department shall review and audit underpayments and
overpayments to providers;
  • If the department determines that an overpayment occurred
because services could have been provided at a lower cost
setting, the overpayment is the difference between the
amount paid and the amount due if the services had been
provided under other circumstances;
  • Any overpayment review evaluating medical necessity
must be conducted by a Colorado physician relying only on
the information available at the time of treatment;
  • The department shall not declare the existence of an
overpayment until providers have exhausted all
administrative and judicial remedies;
  • If the department determines that there has been an
underpayment, the department shall pay the provider the
amount due because of the underpayment, plus interest;
  • Reimbursement for covered services, including amounts
collected for an overpayment, must be in an amount
adequate to ensure access to care;
  • Audits and reviews must not occur more than 3 years after
the date the claim was filed;
  • Notices of adverse action that fail to comply with
department rules are void;
  • In an appeal of a determination of overpayment or
underpayment, an administrative law judge's ruling must be
published on the department's website and other
administrative law judges may rely on previous rulings as
  • The department shall annually identify billing errors
common across multiple providers to enable providers to
correct the errors;
  • The department may contract with a qualified agent to
review or audit payments to providers for both
overpayments and underpayments and must protect against
conflicts of interest;
  • In any contingency-based contract for review or audit of
payments, the compensation must not exceed 12.5% of the
amount of overpayments collected and the amount due
because of underpayments determined;
  • At least quarterly, the department shall publish on its
website an audit activity report detailing current and
recently completed audits and reviews and summaries of
the findings of such audits and reviews and a copy of the
contracts, scopes of work, and information regarding
supervision of contractor deliverables for audits and
  • The department shall create a provider advisory group to
advise the department on issues that providers have
concerning the audits and reviews; and
  • The department shall contract for an independent review of
reviews and audits conducted from the 2018-19 to the
2022-23 state fiscal years for compliance with coding
practice standards and state law.

Committee Reports
with Amendments
Full Text
Full Text of Bill (pdf) (most recent)
Fiscal Notes Fiscal Notes (08/29/2023) (most recent)  
Additional Bill Documents Bill Documents
  • Past bill versions
  • Past fiscal notes
  • Committee activity and documents
  • Bill History
Lobbyists Lobbyists
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Votes House and Senate Votes
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