Medical Billing Services in Colorado
Billing, coding, credentialing and denial management for Colorado practices, with Medicare claims through Novitas Solutions (Jurisdiction JH) and Colorado Medicaid handled by people who know the rules.
Medical billing for Colorado practices
Colorado practices bill Health First Colorado, the state Medicaid program, through a model that splits the work. Most physical health claims are paid fee-for-service by the state, while Regional Accountable Entities under the Accountable Care Collaborative manage care coordination and most behavioral health. Medicare Part B is processed by Novitas Solutions in Jurisdiction H, and the Front Range commercial market includes Anthem, UnitedHealthcare, Kaiser Permanente and Cigna.
Mountain and Western Slope practices add rural access issues, seasonal volume and patients who change plans often. SFA Solutions works with practices across Colorado remotely. Our team works inside your current EHR, sends each Medicaid claim to the state or the correct regional entity, submits most clean claims within 24 hours and works denials through appeal.
Colorado at a glance
| Medicare contractor | Novitas Solutions, Jurisdiction JH |
|---|---|
| Medicaid timely filing | 365 days from the date of service for original claims, with limited exceptions such as backdated eligibility |
| NP practice authority | Full |
| Cities we serve | Denver, Colorado Springs, Aurora, Fort Collins, Lakewood, Boulder, Pueblo, Greeley, Grand Junction |
What Colorado billing involves
These are the programs and rules our team works with for Colorado claims.
Medicare
Novitas Solutions · JHColorado Part B claims are processed by Novitas Solutions in Jurisdiction JH. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Colorado Medicaid
Health First Colorado (Colorado's Medicaid program); Child Health Plan Plus (CHP+) for CHIP
Portal: Health First Colorado Provider Web Portal, operated by the Department's fiscal agent, for enrollment and claims
Medicaid managed care
Under Accountable Care Collaborative Phase III, which began July 1, 2025, four Regional Accountable Entities coordinate care and oversee most behavioral health benefits in their regions, while most physical health claims are paid fee-for-service. Some members are enrolled in managed care plans: Elevate (Denver Health) Medicaid Choice and Rocky Mountain Health Plans PRIME.
Timely filing
365 days from the date of service for original claims, with limited exceptions such as backdated eligibility.
Commercial and Medicare Advantage
Anthem Blue Cross and Blue Shield, UnitedHealthcare, Kaiser Permanente Colorado, Cigna and Rocky Mountain Health Plans are the largest commercial payers. Medicare Advantage is common along the Front Range.
Prompt pay law
C.R.S. 10-16-106.5 requires carriers to pay, deny or settle clean claims within 30 calendar days if submitted electronically and 45 calendar days by other means, with 10% annual interest on late payments.
Nurse practitioners
Full practiceColorado nurse practitioners can practice without a physician collaboration agreement. Before full prescriptive authority, NPs complete 750 hours of mentored prescribing experience with a physician or APRN mentor, so check the Colorado Board of Nursing for current requirements.
Credentialing
Providers enroll with Health First Colorado through the Health First Colorado Provider Web Portal, and behavioral health providers also contract with the Regional Accountable Entity for their region. Commercial carriers such as Anthem, UnitedHealthcare and Cigna use CAQH ProView. Medicare enrollment goes through PECOS with Novitas JH.
Billing challenges Colorado practices face
State versus regional billing
Physical health claims for most Health First Colorado members go to the state, while many behavioral health services go to the member's Regional Accountable Entity. Sending a claim to the wrong place causes a denial that costs weeks. The member's enrollment lookup shows both assignments and should be checked before billing.
Phase III transition
The Accountable Care Collaborative moved to Phase III on July 1, 2025, with four regions. Practices that relied on old region assignments or contracts may see claims routed incorrectly. Reviewing your contracts and payer setup against the current regions helps prevent avoidable denials.
Mixed Medicare coverage
Front Range seniors are split between Original Medicare through Novitas and a wide range of Medicare Advantage plans. Plan changes at open enrollment create early year eligibility denials. Re-verifying coverage in January keeps those claims clean.
Our services in Colorado
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Colorado
Colorado medical billing questions
What is the timely filing limit for Health First Colorado?
Original claims must be filed within 365 days from the date of service. Once that period has passed, a resubmitted claim must arrive within 60 days of the last action on it, and backdated eligibility has its own rules. Most clean claims are submitted within 24 hours, well inside that limit.
Where do I send Health First Colorado behavioral health claims?
Most behavioral health services for Health First Colorado members are billed to the member's Regional Accountable Entity, while most physical health claims go to the state fee-for-service system. Members in a managed care plan follow that plan's rules. The member's eligibility record shows which entity applies.
How fast must Colorado insurers pay clean claims?
Under C.R.S. 10-16-106.5, carriers must pay, deny or settle clean electronic claims within 30 calendar days and clean claims sent by other means within 45 calendar days. Late payments accrue interest at 10% per year.
Who is the Medicare contractor for Colorado?
Novitas Solutions processes Medicare Part B claims for Colorado under Jurisdiction H. Enrollment changes go through PECOS, and Novitas local coverage determinations apply.
Get a free billing audit for your Colorado practice
We will review your recent claims and denials against Colorado payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction H (JH)
- HCPF ACC Phase III behavioral health provider fact sheet
- HCPF Intermediate Billing training (timely filing)
- Colorado General Assembly: Colorado Revised Statutes (C.R.S. 10-16-106.5)
- AANP Colorado state fact sheet (practice environment)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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