CO · guidance
CO HCPF Managed Care Programs Billing Manual — Fee-For-Service Benefits for MCO-Enrolled Members
Fee-For-ServiceBenefitsforMCO-EnrolledMembers
HealthFirstColoradopaysFFSclaimsforMCO-enrolledmembersunderthefollowingcircumstances:
WhenaHealthFirstColoradobenefitisnotprovidedbytheMCO,thebenefitmaybereferencedintheMCOcontractandreferredtoasawrap-around"benefit,or
WhenthememberhasexhaustedMCObenefitsandrequiresadditionalmedicallynecessaryHealthFirstColoradobenefitservices.
FFSclaimsforservicesprovidedtoMCOenrolledmembersmusthavethefollowingattachments:
Abenefitsexhaustedstatement(explanationofbenefits)forMCOexhaustedbenefits.
AstatementfromtheMCOindicatingtheserviceisnotaprovidedMCObenefit.IftheMCOroutinelydoesnotprovideaspecificservice(e.g.,nursingfacility,physicaltherapy,etc.),thenon-benefitstatementisoptional.Benefitcoveragemayvaryfromone(1)MCOtoanother.
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
699c24fdd3668cc5f391bd764f825dbb1ab92daf5d8f805db5d960554e40b2fd
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