Medical Billing in Colorado
Soft Home Global provides billing, AR follow-up and denial appeals for Colorado practices and billing companies at $1,800 per seat per month. Full time, worked during Colorado business hours, inside your own system.
What is specific to Colorado
Health First Colorado runs through the Accountable Care Collaborative, where Regional Accountable Entities coordinate care and hold the behavioral health benefit while most physical health claims are still paid fee-for-service by the state.
Colorado’s Medicaid programme is Health First Colorado. Practices with a meaningful Health First Colorado mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a medical billing seat does in Colorado
Aged accounts receivable called until they close, and denials read, appealed and tracked.
In Colorado the queue that costs the most is Health First Colorado, because its filing window and appeal route are not the commercial ones.
- Worklist worked from the difficult end, not the easy end
- Every call logged with the payer reference and the outcome
- Denials categorised so the same reason stops recurring
- Appeals written and submitted, not just re-bills
- Weekly written summary of what moved and what did not
- Worked during Colorado business hours, not queued overnight
Most of the Colorado work we see comes out of Denver, Colorado Springs and Aurora, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.
Colorado borders 7 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from Health First Colorado, and it is the queue that most often goes unworked because it belongs to nobody.
What Colorado law gives you
30 calendar days for clean claims submitted electronically; 45 calendar days for clean claims submitted by any other means (C.R.S. 10-16-106.5(4)(a))
Health First Colorado, in practice
Health First Colorado runs no comprehensive risk-based MCOs — in CMS's 2024 managed-care enrollment file Colorado's only non-PACE managed care is the 'Accountable Care Collaborative (PCCM Entity),' delivered through seven Regional Accountable Entities (listed as RAE 1 Rocky Mountain Health Plans, RAE 2 Northeast Health Partners, RAE 3 and RAE 5 Colorado Access, RAE 4 Health Colorado Inc., RAE 6 and RAE 7 Colorado Community Health Alliance) plus Denver Health Medicaid Choice and Rocky Mountain Health Plans PRIME. Source
Colorado sets a hard 90-day outer deadline on every claim, not just clean ones — a pended, disputed or additional-information claim still has to be resolved within 90 calendar days of receipt. Verbatim, C.R.S. 10-16-106.5(4)(c): 'Absent fraud, all claims except those described in paragraph (a) of this subsection (4) shall be paid, denied, or settled within ninety calendar days after receipt by the carrier.' Colorado also requires carriers to run a receipt-confirmation mechanism for non-electronic claims and to list the claim on it within ten business days, with that listing date deemed the date of receipt — which gives a biller a documented start date for the prompt-pay clock on paper claims. Source
On the commercial side the dominant Blue plan here trades as Anthem Blue Cross and Blue Shield (Elevance Health is the BCBS licensee for Colorado), which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source
We have not been able to source Colorado’s own Medicaid filing limit from the regulation itself, so this page does not quote one — the federal floor is twelve months from the date of service and a state may set a shorter window. Ask your Health First Colorado representative for the figure in writing before you rely on it. The states we could source are listed here.
Working Colorado hours
Colorado runs on Mountain time, 12 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 9pm to 5am, and 8pm to 4am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Colorado hours and nobody else’s.
What it costs in Colorado
$1,800
Per seat, per month, in US dollars — $21,600 a year for one full-time person, forty hours a week, on Colorado hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Colorado run $1,600 to $2,650; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Colorado
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Colorado practices?
Yes. Colorado accounts are worked during Colorado office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Colorado?
Health First Colorado runs through the Accountable Care Collaborative, where Regional Accountable Entities coordinate care and hold the behavioral health benefit while most physical health claims are still paid fee-for-service by the state.
When does a Colorado payer have to pay a clean claim?
30 calendar days for clean claims submitted electronically; 45 calendar days for clean claims submitted by any other means (C.R.S. 10-16-106.5(4)(a)) A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does medical billing cost in Colorado?
$1,800 per seat per month — $21,600 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Colorado queue?
Colorado is on Mountain time, 12 hours behind Rawalpindi. The shift here runs 9pm to 5am so your seat is at a desk for your full working day, shifting to 8pm to 4am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Health First Colorado as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Health First Colorado has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your Colorado work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com