CO · guidance
CO HCPF Inpatient/Outpatient (IP/OP) Billing Manual — Third-Party Payment Prorate
Third-PartyPaymentProrate
Whenaproviderreceivesathird-partylumpsumpaymentformultipleservicesbilledtoHealthFirstColoradoonseparateclaimforms(e.g.,hospitalstayandtransportation),theprovidershouldproratethethird-partypaymenttothemultipleservices/claims.
Eachclaimmustincludeacopyoftheinsurancecompany'sExplanationofBenefits(EOB)orcheckwithanotationthatthepaymenthasbeenappliedtomultipleclaims.
Example(foroutpatientandtransportationservices):Servicesincurredwere:Outpatient$800Transportation$200TotalBilledtoThird-PartyPayer$1000Lump-sumpaymentreceivedfromThird-PartyPayer$700
Toproratethird-partypaymentformultipleHealthFirstColoradoUB-04institutionalclaims,determinewhatpercentageofthetotalchargeisrepresentedbyeachclaimamount.Divideeachindividualclaimchargebythetotalcharge.
OutpatientServices$800÷$1,000=80%TransportationServices$200÷$1,000=20%
Todeterminethecorrectthird-partypaymentamounttoenteroneachclaim,multiplyeachpercentagefromthepreviouscalculationtimesthetotalamountreceivedfromthethird-partypayer.
TheseamountsshouldbeenteredontheThird-PartyPayerlineinformlocator54(PriorPayments).
80%x$700=$560ontheOutpatientclaim20%x$700=$140ontheTransportationclaim
TheamountfortheHealthFirstColoradolineinformlocator55(EstimatedAmountDue)isthedifferencebetweenthetotalclaimchargeandthethird-partypayerprorateamount.
Outpatient$800-$560=$240Transportation$200-$140=$60
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
746cfd3f8578081a245e235ab795d5f8b683985ac5adfaed44b4b5e4d71e28f5
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