CO · guidance
CO HCPF Private Duty Nursing Billing Manual — Special Reimbursement Conditions for Private Duty Nursing Services
SpecialReimbursementConditionsforPrivateDutyNursingServices
Adenialmustbekeptinthemember'srecordandupdatedannuallyontheanniversaryofthedenial.
Thethird-partyinsurancedenialsmustbebasedonnon-coverageandnotduetothefailureofadheringtotherequirementssetforthbytheinsuranceagency.
HealthFirstColoradowillnotaccepta"no-pay"denial(typeofbill320,conditioncode21)fromMedicareasavaliddenialofMedicarecoverage.
IntheeventoflimitednursingresourcesforaHomeHealthAgency(HHA),two(2)HHAsmaycoordinatecareandprovideservicestothesamememberaslongasthereisnoduplicationofservicesonthesamedate(s)ofserviceandeachproviderobtainsaPAR.
PDNservicesmaybeprovidedbyasinglenursetoanindividualortomultipleindividualsinanon-institutionalgroupsetting.Thenurse:memberratioshallnotexceedwhatispermissibleforone(1)licensednursetosafelycareforeachmembersimultaneously,basedonmemberacuityandtheavailabilityofadditionalsupportinthehome
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Provenance
- Source
- hcpf.colorado.gov
- Retrieved
- 2026-07-26
- Edition
- 2026-07-26
- Content hash
d067dc2f13de67af192de55c52ad66b73bf3f1726769d38201fa3ba2bf6b1ffa
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