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Information for Out-of-Network Providers

Referrals/Authorizations

In general, all services rendered by out-of-network (non-participating) providers require prior authorization for payment by Colorado Access.  Please review the Colorado Access General Authorization rules located on our Web site at http://www.coaccess.com/authorizations-and-referrals  for more information.

Timely Filing of Claims

The timely filing of claims is specific to line of business (or health plan).

  • For Access Behavioral Care, Colorado Access Health Plan (Medicaid), and CHP+ offered by Colorado Access (our CHP+ HMO), the timely filing deadline is 120 days. 
     
  • For the CHP+ State Managed Care Network, the timely filing deadline is 180 days. 
     
  • For Colorado Access Advantage (Medicare), please use the following table to determine the timely filing deadline:

Date of Service
Jan
Feb
Mar
Apr
May
June
Timely Filing Date
Dec:31:
Service year plus one year
Dec 31:
Service year plus one year
Dec 31:
Service year plus one year
Dec 31:
Service year plus one year
Dec 31:
Service year plus one year
Dec 31:
Service year plus one year
Months to file*
23
22
21
20
19
18
 
 
 
 
 
 
 
Date of Service in:
July
Aug
Sept
Oct
Nov
Dec
Timely filing date
Dec 31:
Service year plus one year
Dec 31:
Service year plus one year
Dec 31:
Service year plus one year
Dec 31:
Service year plus two years
Dec 31:
Service year plus two years
Dec 31:
Service year plus two years
Months to file*
17
16
15
26
25
24

* “Months to file” represents the number of full months plus the remainder of the service months

If you have additional questions regarding claims, please visit our Frequently Asked Questions page.

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