During the 2019 legislative session, HB 19-1174 was passed to protect patients from surprise bills for health care services from out-of-network providers. The legislation designates the Colorado All Payer Claims Database (CO APCD) as a data source for determining payment for out-of-network provider and emergency services. The CO APCD is specifically being used to calculate the 50th percentile paid (allowed) amounts for Emergency Department visits and 60th percentile paid amounts for Professional/Anesthesiology services by region and statewide. The bill went into effect on January 1, 2020, and the first datasets generated by CIVHC and other related resources are now available on the Division of Insurance (DOI) website.
- HB 19-1174: http://leg.colorado.gov/bills/hb19-1174
- Out-of-Network Health Care Provider Reimbursement – Division of Insurance: https://www.colorado.gov/pacific/dora/out-network-health-care-provider-reimbursement