HCPF says >750,000 claims require adjustment after hospital rate changes; fiscal agent processing through January

Andrew Avalos, facility rate section manager at the Colorado Department of Health Care Policy & Financing, told participants the department implemented multiple outpatient hospital rate changes last year with effective dates of July 1 and Oct. 1. He said timing constraints required waiting for EAPG version and 340B pricing updates before performing hospital-specific base-rate updates.

Avalos said those updates were completed Dec. 17, but their timing meant "more than 750,000 claims requiring adjustment," and the department "has just less than the, 400,000 of those claims being adjusted" so far. He said the fiscal agent is continuing to perform adjustments and that the work is likely to take through January to complete.

Avalos also said providers were notified by email on Dec. 31 about the rate changes and related adjustments and pointed attendees to slides with contact emails (Sean Pashke and Avalos) for rate questions. He encouraged providers to review the linked website materials if they have further questions about the new rates.

Separately, Avalos described upcoming and recent EAPG module updates: a Solventum general availability release issued Dec. 23 is scheduled for installation into the MMIS, affecting CPT and HCPCS updates effective Jan. 1, and another Solventum release is planned toward March. The department said it will review and adjust claims after each module update.

Avalos cautioned that the volume of adjustments is large and cannot be completed instantly but committed to continuing work and communications until adjustments are finished.