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CO HCPF Nurse Home Visitor Program Billing Manual — Documentation in Member Records

DocumentationinMemberRecords

activein force · 2026-07-26 – presentas-observed

EveryclaimforTCMreimbursementmustbesupportedbyclearevidenceinthemember'srecord/chart.InorderforTCMreimbursementtobeclaimedforanygivenmember,date,orunitamount,correspondingevidencemustexistinthemember'srecord.

Elementsthatshouldbeeasilyidentifiablebyanexternalreviewerinclude:

Evidencethatatleastone(1)componentofTCMwasprovided,

TheHealthFirstColoradomembertowhomoronbehalfofwhomtheTCMwasprovided(Iftheclaimisbilledusingthechild'sHealthFirstColoradoID,thechild'snamemustbeevidentontherecord.),

ThespecificdatesofserviceonwhichtheTCMwasrendered,and

TheamountoftimespentprovidingTCM(eitheranactualnotationoftimeoradescriptionofservicescomprehensiveenoughthattimespentprovidingTCMcouldbeaccuratelyestimated).

Thenotationsinthechartshouldsupportthenumberofunitsbilled.Forinstance,iftwo(2)unitsofTCMarebilledbuttheonlynotationinthechartreads,"ReferredmembertoWIC,"thatnotationdoesnotnecessarilysupportthenumberofunitsbilled.Amorecompletereferencethatmaymorefullysupportthenumberofbilledunitscouldbe,"Spokewithmemberaboutquantityandvarietyoffoodinhousehold,assessedmemberforadequatenutritionstandards,referredmembertoWICtomeetnutritionneeds."

TargetedCaseManagementservicesprovidedtooronbehalfofthemothershouldbebilledusingthemother'sHealthFirstColoradoIDandthenotationsinthechartshouldsupportthattheserviceswereprovidedtooronbehalfofthemother.TargetedCaseManagementservicesprovidedtooronbehalfofthechildshouldbebilledusingthechild'sHealthFirstColoradoIDandevidenceinthechartshouldsupportthattheserviceswereprovidedtooronbehalfofthechild.ServicesprovidedtooronbehalfofthemotheraftersheisnolongereligibleforHealthFirstColoradoarenotbillabletoHealthFirstColoradoandmaynotbebilledusingthechild'sHealthFirstColoradoID.Foreveryclaimsubmittedusingthechild'sHealthFirstColoradoID,evidenceinthechartsupportingthisclaimandunitamountshouldspecificallydescribeTCMservicesprovidedtooronbehalfofthechild.

Evenifspanbillingisused,theremustbeevidenceinthemember'schartofspecificservicesandspecificdatesofservice.RefertotheSpanBillingsectionbelow.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 8eb7de7f672f9cbf94d2ae81f2d291d7a22fcc02886f518374d0a4a894a2289f

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