Ensuring Appropriate Claims Payment

Upcoming Improvements to Claims Review

The Department of Health Care Policy & Financing (the Department) is committed to improving health and quality services to our members while ensuring appropriate claims payments to Health First Colorado (Colorado’s Medicaid Program) providers.

In accordance with Senate Bill 18-266, the Department is implementing its Ensuring Appropriate Claims Payment project. The project is comprised of two components:

  • For outpatient hospital payments, the Department and its contractor, DXC Technologies (DXC) are working to map 3M EAPG return codes to edits in the Colorado interChange.
  • For other professional and outpatient claim types, the Department and DXC are working with Change Healthcare to implement its ClaimsXten™ tool to automatically review claims for appropriate billing practices. The first phase of ClaimsXten™ implementation will exclude home and community-based services (HCBS) claims.

The Ensuring Appropriate Claims Payment project was implemented effective September 26, 2020, and is now live. Please contact the Provider Call Center with any questions.

ClaimsXten™ Provider Training Schedule