CO · guidance
CO HCPF Inpatient/Outpatient (IP/OP) Billing Manual — Out-of-State Hospital Services
Out-of-StateHospitalServices
Out-of-statehospitalsareclassifiedasurbanorrural.Abaserateof90%oftheColoradourbanorruralbaserateisusedforthepurposeofreimbursementcalculationundertheHealthFirstColorado(Colorado'sMedicaidprogram)All-PatientRefinedDiagnosisRelatedGroup(APR-DRG)andEnhancedAmbulatoryPatientGrouping(EAPG)paymentmethodologies.
VisittheInpatientHospitalPaymentwebpageforfurtherinpatientbaserateinformation.
VisittheOutpatientHospitalPaymentwebpageforfurtheroutpatientbaserateinformation.
Non-emergentout-of-stateinpatientservicesmustbepriorauthorized.InpatientPriorAuthorizationRequests(PARs)mustbesubmittedviatheColoradoPARProgram.RefertotheGeneralPriorAuthorizationRequirementssectionabove.
ToqualifyforaSingleCaseAgreement(SCA),thefollowingrequirementsmustbemet:
Theservicesmustbehospitalservices.
TheservicesmustnotbeavailableinColorado.
Theservicesmustbepriorauthorized.
Requestsforpriorauthorizationsolelytomeetthecriteriaabovearenotgranted.Theserviceorstaymustrequirepriorauthorization.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
f88a28e88dbbad323e870b8a5a97a2fa5e517ffda945fd1e80f3679e30b8416c
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