CO · guidance
CO HCPF Community First Choice (CFC) Billing Manual — Claim Submission
ClaimSubmission
Submissionofclaimsforservicesrenderedmustnotbeduplicative.ProviderAgenciescannotbereimbursedfordeliveringthesameservicetothesameMemberonthesamedayatthesametime,whethersuchservicesarebilledonthesameclaimoronmultiple/differentclaims.Additionally,ProviderAgenciesarebarredfrombillingservicesthatshareorhaveoverlappingservicedefinitionsbutaredescribedbydifferentprocedurecodesonthesamedaytothesameMember.Collectivelyreferredtoasduplicateclaims,reimbursementforsuchclaimsrequirescleardocumentationofthenecessityoftheserviceandthattherewasnotduplicativeservicedelivery.RefertotheservicedefinitionsontheColoradoCodeofRegulationswebsitetoidentifyifclaimsareduplicativebasedonservicesrendered.RefertotheProviderspecialtycodeenrollmentrequirementsontheHCBSProviderSpecialtyCodeListwebpagetoidentifyservicesthatmaybeprovidedbyanindividualprovider.ProviderAgenciesmayonlybillforservicesapprovedinMembers’serviceplans.
InanyinstanceinwhichduplicateclaimsubmissionresultsinMedicaidreimbursement,theDepartmenthastheauthoritytorecoupfundsfromProviderAgencies.
RefertotheGeneralProviderInformationManuallocatedontheBillingManualswebpageundertheGeneralProviderInformationdrop-downmenuforgeneralbillinginformation,includingclaimssubmission.
BacktoTop
Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
3ac093b9c949ddf9168e01e6821bed7e2af2d5de24572eaba7a4d0a26e2b5825
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.