CO · guidance
CO HCPF Physician-Administered Drugs (PAD) Billing Manual — Record Keeping and Retention
RecordKeepingandRetention
Providerswhoadministerand/ordispensePhysician-AdministeredDrugs(PADs)arerequiredbytheProviderParticipationAgreementwiththeHealthFirstColoradoprogramandColoradoStateRule8.130.2(ProgramRulesandRegulations)tomaintainrecordsnecessarytodisclosethenatureandextentofservicesprovidedtomembers.
Providersmustmaintainrecordsthatfullydisclosethenatureandextentofservicesprovided.Uponrequest,providersmustfurnishinformationaboutpaymentsclaimedforHealthFirstColoradoservices.Recordsmustsubstantiatesubmittedclaiminformation.Suchrecordsincludebutarenotlimitedto:
Billinginformation
Treatmentplans
Priorauthorizationrequests
Medicalrecordsandservicereports,andordersprescribingtreatmentplans
Recordsandoriginalinvoicesforitems,includingdrugsthatareprescribed,orderedorfurnished
Claims,billingsandrecordsofHealthFirstColoradopaymentsandamountsreceivedfromotherpayers
Recordsofprovidersshallincludeemploymentrecords,includingbutnotlimitedtoshiftschedules,payrollrecordsandtime-cardsofemployees.
Providerswhoissueprescriptionsshallkeepinthepatient'srecord,thedateofeachprescriptionandthename,strengthandquantityoftheitemprescribed.
Eachprovidershallretainanyotherrecordscreatedintheregularoperationofbusinessthatrelatetothetypeandextentofgoodsand/orservicesprovided(forexample,superbills).Allrecordsmustbelegible,verifiableandmustcomplywithgenerallyacceptedaccountingprinciples,auditingstandardsandallapplicablestateandfederallaws,rulesandregulations.
Eachmedicalrecordentrymustbesignedanddatedbythepersonorderingandprovidingtheservice.Computerizedsignaturesanddatesmaybeappliediftheelectronicrecord-keepingsystemmeetsHealthFirstColoradosecurityrequirements.
Theserecordsmustfullysubstantiateorverifyclaimssubmittedforpaymentandmustbefurnishedonrequesttotheauthorizingagency.Recordsmustberetainedforatleastseven(7)yearsorlongerifrequiredbyregulationoraspecificcontractbetweentheproviderandtheHealthFirstColoradoprogram.
AttherequestoftheUSDepartmentofHealthandHumanServices(HHS),theDepartment,theColoradoDepartmentofHumanServices,ortheMedicaidFraudControlUnit(MFCU),andattherequestofanyoftheirauthorizeddesignees,recordverificationmayinclude,butwillnotbelimitedto,interviewswithproviders,employeesofproviders,billingservicesthatbillonbehalfofproviders,andanymemberofacorporatestructurethatincludestheproviderasamember.
Backtotop
Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
904affa7c04615e28c38e681c7166e19c2b469930f68d59d26113a2d8093c719
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