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 Health Care Provider Reimbursement Regulations
Out-of-Network APCD Reimbursement Datasets
CIVHC/CO APCD Out-of-Network Reimbursement Datasets:
- HB 19-1174 Re-issued CO APCD Reimbursement Dataset - 60th Percentile Allowed Amounts for Out-of-Network Professionals - Includes Anesthesiology - Reissued October 21, 2020
- HB 19-1174 Re-issued CO APCD Reimbursement Dataset - 50th Percentile Allowed Amounts for Out-of-Network Emergency Services - Reissued October 21, 2020
CO APCD Calculated Allowed Amounts to Support Implementation of House Bill 19-1174 - October 2020 Update
Past APCD Documents:
- Summary of Impact of Corrections to Out-of-Network Fees Schedules for Re-issued CO APCD Reimbursement Dataset - From CIVHC/APCD
- Overview and Methods used for Re-issued CO APCD Reimbursement Dataset - From CIVHC/APCD
FAQ from Center for Improving Value in Health Care (CIVHC) - CIVHC's Colorado All Payer Claims Database (CO APCD) is specifically identified in the bill as a data source for the implementation of HB19-1174.
Out-of-Network Arbitration Program
Out-of-Network Arbitration Request Form [Fillable PDF]
Arbitration Decision and Reporting Form [Fillable PDF]