Medical Billing Services in Colorado
As a remote-first medical billing company serving Colorado practices statewide, MedPrecision pairs CO-specific payer expertise with AAPC-certified billing experts. Practices in Colorado work against three separate clocks: Health First Colorado's 365-day timely-filing window, each commercial plan's own appeal deadlines, and the state prompt-pay rule. Colorado Revised Statutes 10-16-106.5 (4)(a) gives a carrier thirty calendar days to pay, deny, or settle a clean claim submitted electronically and forty-five calendar days when it arrives by any other means, and subsection (5) attaches interest and a penalty when it does not (statute text read on 2026-09-17). That section binds carriers regulated under Colorado insurance law — self-funded employer plans answer to ERISA instead, and workers' compensation claims are excluded outright. Our remote billing team builds Colorado-specific workflows around these rules, with payer-level edits, regional-entity portal routing, and appeal drafts queued the moment a denial lands.
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The Colorado Billing Landscape
Colorado's billing landscape is defined by Health First Colorado, the state's Medicaid program, which runs through the Accountable Care Collaborative. ACC Phase III contracts started on July 1, 2025 and put four Regional Accountable Entities in place — Rocky Mountain Health Plans in Region 1, Northeast Health Partners in Region 2, Colorado Community Health Alliance in Region 3, and Colorado Access in Region 4 — each administering the capitated behavioral health benefit and coordinating physical health services for its region, with RMHP PRIME and Elevate (Denver Health) Medicaid Choice delivering physical health care as managed care plans in parts of the state. Practices that billed a Phase II entity should re-check member attribution against the Phase III regions before submitting. Commercial claims run mostly through Anthem Blue Cross Blue Shield, UnitedHealthcare, Cigna, and Kaiser Permanente. Colorado was an early adopter of a state health insurance exchange (Connect for Health Colorado), and HB 21-1232 created the Colorado Option, a standardized individual and small-group plan the commissioner of insurance establishes by rule. On the payment side, Colorado Revised Statutes 10-16-106.5 gives a carrier thirty calendar days to pay, deny, or settle a clean electronic claim and forty-five days for any other submission method, with interest from the due date and a penalty at ninety days behind it — which makes the submission method itself a revenue decision. Geography splits the state into distinct billing environments: Denver metro practices bill a mostly commercial book, while Western Slope and mountain communities lean on rural health clinic designations and telehealth, which section 10-16-123 requires carriers to reimburse on the same basis as in-person care.
Who We Serve in Colorado
Our Colorado client mix skews toward solo practices, group practices, behavioral health practices , plus urgent care centers and telehealth providers. We work with providers in Denver, Colorado Springs, Aurora and across the rest of the state, all remotely.
Major Metros Served
What billing costs in Colorado
We publish one national rate card and bill Colorado practices on exactly the same terms as everywhere else — there is no regional markup and no quote-only tier below enterprise. You pay a percentage of what we actually collect, so if we do not collect, you do not pay.
| Practice size | Rate | Basis | Note |
|---|---|---|---|
| Solo practice | 7.0% | of monthly collections | Monthly minimum applies |
| Group practice | 6.0% | of monthly collections | Volume discounts available |
| Enterprise | Custom | tiered pricing | Scoped per engagement |
- No setup or implementation fee
- No per-claim charge
- No software fee and no markup on third-party costs — clearinghouse fees, postage and payer application fees are passed through at cost
- 12-month initial term, then month-to-month — 60 days' notice either way, no early-termination penalty
Payer Landscape in Colorado
Health First Colorado (Accountable Care Collaborative Phase III — four Regional Accountable Entities since July 1, 2025) routes members through Rocky Mountain Health Plans (RAE Region 1), Northeast Health Partners (RAE Region 2), Colorado Community Health Alliance (RAE Region 3) and 2 more plans, each with its own authorization rules and fee schedule. On the commercial side, Anthem Blue Cross Blue Shield, Kaiser Permanente, UnitedHealthcare drive the bulk of Colorado claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in Colorado run 365 days for Medicaid and 90-180 days for commercial payers — deadlines our A/R queues are built around. Colorado's prompt-pay statute: Colorado Revised Statutes 10-16-106.5 (4) requires a carrier to pay, deny, or settle a clean claim within thirty calendar days when it is submitted electronically and forty-five calendar days by any other means. Subsection (5) adds ten percent annual interest from the date payment was due, and a twenty percent penalty on the ninety-first day. It binds carriers subject to Colorado insurance law; self-funded employer plans and workers' compensation claims fall outside it.
Medicaid Program
Health First Colorado (Accountable Care Collaborative Phase III — four Regional Accountable Entities since July 1, 2025)
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
Colorado Revised Statutes 10-16-106.5 (4) requires a carrier to pay, deny, or settle a clean claim within thirty calendar days when it is submitted electronically and forty-five calendar days by any other means. Subsection (5) adds ten percent annual interest from the date payment was due, and a twenty percent penalty on the ninety-first day. It binds carriers subject to Colorado insurance law; self-funded employer plans and workers' compensation claims fall outside it.
Colorado Billing Regulations & Compliance
The Colorado Division of Insurance (DORA) sets the rules our Colorado billing workflows have to satisfy. Surprise billing in Colorado: Colorado HB 19-1174 (2019 session laws ch. 171, effective January 1, 2020) requires carriers, providers, and facilities to disclose out-of-network exposure, sets the claims and payment process for out-of-network services, and fixes the reimbursement owed for out-of-network care delivered at an in-network facility and for out-of-network emergency services. Telehealth parity: Colorado Revised Statutes 10-16-123 bars a health benefit plan from requiring in-person contact for services telehealth can appropriately deliver, and requires a carrier to reimburse a participating provider for a telehealth service on the same basis as the same service delivered in person — subject to the plan's own terms and conditions. Health First Colorado covers telemedicine, with the modality rules set by Department of Health Care Policy and Financing policy rather than by the insurance code, so confirm the current rule for audio-only before billing it.
State Insurance Regulator
Colorado Division of Insurance (DORA)
Surprise Billing Protection
Colorado HB 19-1174 (2019 session laws ch. 171, effective January 1, 2020) requires carriers, providers, and facilities to disclose out-of-network exposure, sets the claims and payment process for out-of-network services, and fixes the reimbursement owed for out-of-network care delivered at an in-network facility and for out-of-network emergency services.
Telehealth Billing Parity
Colorado Revised Statutes 10-16-123 bars a health benefit plan from requiring in-person contact for services telehealth can appropriately deliver, and requires a carrier to reimburse a participating provider for a telehealth service on the same basis as the same service delivered in person — subject to the plan's own terms and conditions. Health First Colorado covers telemedicine, with the modality rules set by Department of Health Care Policy and Financing policy rather than by the insurance code, so confirm the current rule for audio-only before billing it.
Common Questions
Common questions about medical billing services in Colorado.
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Get a Free Billing AuditHow does MedPrecision handle Health First Colorado billing?
Health First Colorado is delivered through the Accountable Care Collaborative. ACC Phase III contracts started on July 1, 2025 and put four Regional Accountable Entities in place — Rocky Mountain Health Plans in Region 1, Northeast Health Partners in Region 2, Colorado Community Health Alliance in Region 3, and Colorado Access in Region 4 — with RMHP PRIME and Elevate (Denver Health) Medicaid Choice delivering physical health care as managed care plans in parts of the state (Department of Health Care Policy and Financing, ACC Phase III page, read 2026-09-17). We build the referral, authorization, and claim-routing workflow around whichever entity holds your patients, and track every claim against the program's 365-day filing window.
How do you coordinate with Colorado's Regional Accountable Entities?
Each Regional Accountable Entity administers the capitated behavioral health benefit and coordinates physical health services for its region, and each publishes its own authorization and care-coordination requirements. We confirm which entity a member is attributed to before the visit, route referrals and prior authorizations to that entity rather than the one that covered the patient last year, and re-check attribution when a patient moves between regions — a mis-routed authorization is one of the cheapest denials to prevent and one of the slowest to unwind.
What are Colorado's prompt pay laws and how do you enforce them?
Colorado Revised Statutes 10-16-106.5 (4)(a) gives a carrier thirty calendar days to pay, deny, or settle a clean claim filed electronically and forty-five calendar days for one filed any other way; if the carrier needs more information it has to ask in writing within thirty days. Subsection (5) is the part with teeth: ten percent annual interest on the amount ultimately allowed, running from the date payment was due, plus a twenty percent penalty imposed on the ninety-first day after receipt if the claim is still unresolved. Our claims aging system flags overdue payments against those dates so the interest is pursued instead of written off.
Do you specialize in behavioral health billing for Colorado practices?
Yes. Behavioral health sits inside the Regional Accountable Entity's capitated benefit in Health First Colorado, so a mental health or substance use claim is adjudicated by the member's regional entity rather than by the fee-for-service program — which is why attribution and authorization routing matter more here than in most states. We bill behavioral health and substance use services to the correct entity and handle the coding and documentation those plans require. Parity questions — whether a plan is applying tighter limits to behavioral health than to medical or surgical benefits — turn on the plan type and the rule that governs it, so we escalate those with the claim history attached rather than answering them generically.
What happens if a payer misses the Colorado prompt-pay deadline?
The interest clock in Colorado Revised Statutes 10-16-106.5 (5) starts the day payment was due: ten percent annual interest on the amount ultimately allowed, and a twenty percent penalty imposed on the ninety-first day after the carrier received the claim if it has still not paid, denied, or settled it. We track every clean claim against those dates, flag stalled payments in our A/R reports, and escalate to the Colorado Division of Insurance when a carrier defaults. Note the limits: the section covers state-regulated carriers, not self-funded employer plans, and not workers' compensation. Health First Colorado claims run a separate 365-day filing window from the date of service, and commercial filing limits run 90-180 days — we build follow-up cadences around both.
How do I choose a medical billing company in Colorado?
Prioritize a billing company that already works with Health First Colorado and the major commercial payers in Colorado — payer-specific edits and timely-filing windows are where most CO revenue leaks start. Ask about AAPC-certified coders, transparent pricing, and denial-rate and days-in-A/R reporting before you sign. Because billing is delivered remotely, a company's Colorado payer experience matters more than a local office address.
Services for Colorado practices
Specialties we bill for
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Services in Colorado
Specialties in Colorado
Other Locations We Serve
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