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HCPF details Rural Health Clinic reconciliation letters, rate posting, 2026 rates and audit options
Summary
Department staff said reconciliation demand letters were sent in April starting a 30-day appeal window, that 2026 RHC rates were implemented in February, and that the department will post aggregated RHC rates publicly; staff also outlined scope-of-service adjustments and managed-care accuracy audit participation options.
Andrew Avalos, facility rate section manager at the Colorado Department of Health Care Policy & Financing, provided several operational updates for Rural Health Clinics (RHCs) during the April 30 engagement meeting.
Reconciliations and demand letters: Avalos said the department has aggregated 2025 work into 2026 reconciliation work and sent reconciliation demand letters in April, which begin a 30-day appeal window. He said if finalized rates are lower than amounts already paid, the department will set up accounts receivable to recover funds; conversely, if finalized rates are higher than interim payments, the department will issue additional…
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