Out-of-Network Health Care Provider Reimbursement

Reporting Deadline Extended for Out-of-Network Data

The Division of Insurance notifies all applicable carriers their due date to submit Out-of-Network data for the submission period of 1/1/20 - 9/30/20 has been extended to February 1, 2021. The original deadline for these data was Dec 31, 2020. This is a one time only extension and does not impact other due dates carriers have for Out-of-Network Data as stated in Colorado Insurance Regulation 4-2-74. 

House Bill 19-1174 was passed by the Colorado Legislature to help protect patients from surprise out-of-network bills 

The bill includes provisions for how health insurance carriers will reimburse providers (doctors, hospitals and other health care providers) for out-of-network emergency and non-emergency care. 

Legislation and FAQ: HB19-1174 - Out-of-Network Health Care Services

Out-of-Network APCD Reimbursement Datasets

For Carriers - Out of Network Data Reporting

Regulation 4-2-74 requires that all applicable health insurance carriers report data to the Commissioner of Insurance on the use of out-of-network providers and facilities, as well as the impact on premium affordability. To facilitate carrier submissions of these data the Division of Insurance has created a data reporting template. It is suggested that carriers download the template, fill it out, and email it to all of the following Division staff:

Out-of-Network Carrier Data Reporting Template

Frequently Asked Questions

Any questions about the data reporting template itself, reporting requirements, or issues reporting the required data by the deadlines listed in statute can be directed to the same Division staff listed above.