Medical Billing Services in Colorado
Colorado’s Medicaid program does not work like a standard managed care state. Members are assigned to a regional organization based on where their primary care provider sits, and that organization coordinates care and manages the behavioral health benefit, but it does not take insurance risk the way a traditional managed care plan does. Billing that treats the regional organization as just another plan, or ignores it entirely, creates avoidable denials.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Colorado practices of every specialty, built around the state’s actual payers and programs.
Colorado’s payer landscape
Colorado’s Medicaid program is Health First Colorado, delivered through the Accountable Care Collaborative. Every member belongs to a regional organization, also called a Regional Accountable Entity (RAE), determined by their primary care provider’s location. The four regional organizations are Rocky Mountain Health Plans, Northeast Health Partners, Colorado Community Health Alliance, and Colorado Access. RAEs contract primary care networks, coordinate care, and manage the capitated behavioral health benefit. Denver Health’s Elevate Medicaid Choice also operates as a managed care option. Because the RAE assignment follows the primary care provider, a patient who changes providers can change regions, so the assignment has to be verified, not assumed.
Commercial coverage is led by Anthem Blue Cross Blue Shield of Colorado and Kaiser Permanente, alongside UnitedHealthcare, which sells plans as Rocky Mountain Health Plans, Cigna, and Denver Health Medical Plan. Medicare Advantage prior authorization touches a significant share of schedules in the Denver and Colorado Springs metros.
What MedPlus RCM handles for Colorado practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing. That is the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Health First Colorado, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Denver, Colorado Springs, Aurora, Fort Collins, Boulder, and Grand Junction, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Colorado practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
How is Health First Colorado different from managed care Medicaid?
Members are assigned to a regional organization that coordinates care and manages behavioral health, but the organization does not take full insurance risk like a traditional managed care plan. Physical health billing still runs through Health First Colorado’s framework, while behavioral health authorization runs through the regional organization.
Do you work with Colorado’s regional organizations?
Yes. We bill Health First Colorado across all four regional organizations, Rocky Mountain Health Plans, Northeast Health Partners, Colorado Community Health Alliance, and Colorado Access, as well as commercial and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Colorado practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
