Surprise bills for out-of-network services can negatively impact the financial well-being of Coloradans. In an effort to curb the impact of these bills on patients and the health care system, HB 19-1174 was passed this year specifying how much insurers and patients should pay for different types of out-of-network services. HB 19-1174 includes the Colorado All Payer Claims Database (CO APCD) in the bill as the source of information for understanding regional and statewide commercial health insurance payments.
Center for Improving Value in Health Care (CIVHC) and the Division of Insurance (DOI) have been working together to determine the specific methodology that will be used to calculate payments using the CO APCD. As we’re working through the details, we’ve put together some Frequently Asked Questions that can help provide some guidance to payers and providers.
These FAQs will be updated using the same link as more information is available. They cover several topics, including:
- The general timeline of bill implementation, and payments for ER and regular services
- How calendar year and region is being defined
- When the CO APCD data will be available to the DOI to determine out-of-network payments
- What data you can receive from CIVHC now