Medical Billing Services in Colorado.
Colorado’s Medicaid program—Health First Colorado—covers approximately 1.2 million Coloradans as of June 2025, returning to pre-pandemic levels after peaking at 1.8 million in 2023. Colorado is also home to a unique hospital financing mechanism, the Colorado Healthcare Affordability and Sustainability Enterprise (CHASE), which uses hospital provider fees to leverage federal matching funds and boost Medicaid reimbursements. Happy Billing supports Colorado providers with expertise in Health First Colorado managed care, CHASE compliance, and billing for the state’s dominant health systems including UCHealth, HCA HealthONE, and Intermountain Health (formerly Centura/SCL Health).
Health First Colorado (Colorado Medicaid) Billing
Health First Colorado is administered by the Colorado Department of Health Care Policy and Financing (HCPF). Enrollment stood at approximately 1.2 million as of June 2025—roughly equal to pre-pandemic levels after a 31.8% net decline during the 2023–2024 unwinding process (the largest percentage drop of any state). ACA expansion remains in effect, with approximately 374,517 enrolled in expanded Medicaid as of December 2024. Beginning in 2025, Health First Colorado extended coverage to undocumented pregnant women and children who would otherwise qualify based on income. Federal work requirements under H.R. 1 (effective January 2027) will affect some expansion enrollees.
Managed Care & RAE Structure
Health First Colorado uses Regional Accountable Entities (RAEs) as the primary managed care structure. RAEs coordinate physical and behavioral health services for Medicaid members within defined geographic regions and receive capitation payments from HCPF. The seven RAEs in Colorado are operated by organizations including Colorado Access, Denver Health Medical Plan, Aetna Better Health of Colorado, Anthem BlueCross BlueShield of Colorado, and others. Providers must contract with the applicable RAE(s) serving their region to receive managed care reimbursement.
CHASE (Colorado Healthcare Affordability and Sustainability Enterprise)
The CHASE is a state enterprise that collects healthcare affordability and sustainability fees from hospitals and uses federal matching dollars to increase Medicaid and Colorado Indigent Care Program (CICP) reimbursements. During the October 2023–September 2024 reporting period, CHASE provided more than $494.5 million in increased hospital reimbursements and covered Health First Colorado and CHP+ for more than 427,000 Coloradans. The CHASE reduced hospital uncompensated care costs and the need to cost-shift to commercial payers. Hospitals must comply with CHASE fee assessments and reporting requirements.
Key Colorado Health First Colorado Billing Requirements
- RAE contracts required; providers identify the applicable RAE(s) for their service area through HCPF’s provider portal
- Prior authorization requirements vary by RAE and service type; behavioral health is integrated into RAE structure (not carved out)
- HCPF mandates annual hospital transparency reporting—Hospital Financial Transparency Report and Community Benefit Report
- Nurse Advice Line (1-800-283-3221) is a covered member benefit; telephonic triage services may be billable
- Work requirements effective January 2027 for expansion adults ages 19–64 under H.R. 1; eligibility redeterminations will increase
- Undocumented pregnant women and children newly eligible starting 2025—outreach and enrollment billing opportunities for FQHCs and safety net providers
- CICP (Colorado Indigent Care Program) available for uninsured/underinsured at qualifying hospitals—distinct billing pathway from Medicaid
Major Colorado Health Systems: Billing Landscape
UCHealth dominates the Colorado hospital market, generating $6.7 billion in 2024 patient revenue—more than double its closest competitor—and serving as the largest Medicaid provider in the state with 1.1 million Medicaid admissions and outpatient appointments. The system is also the largest provider of uncompensated care after Denver Health.
UCHealth
UCHealth is the largest nonprofit health system in Colorado, affiliated with the University of Colorado School of Medicine. In FY 2024, UCHealth reported $6.7 billion in patient revenue statewide, a 6.3% operating margin on $514.1 million in operating income, and total profits of approximately $1.2 billion including investment income. UCHealth operates 16+ hospitals and over 150 care locations statewide. UCHealth University of Colorado Hospital in Aurora is the state’s flagship academic medical center. The system is Colorado’s largest Medicaid provider (53% more Medicaid hospital care than the next largest provider) and provided $1.3 billion in community benefits in FY 2024.
HCA HealthONE
HCA HealthONE is Colorado’s only for-profit hospital network and the second-largest hospital system in the Denver metro area with approximately $617 million in 2024 profits. Owned by HCA Healthcare (one of the nation’s largest for-profit hospital companies), HealthONE operates major hospitals including Sky Ridge Medical Center, Presbyterian/St. Luke’s Medical Center, Rose Medical Center, and Swedish Medical Center. HCA HealthONE’s commercial rates are among the highest in Colorado at approximately 369% of Medicare.
Intermountain Health (Peaks Region)
Intermountain Health—formerly Centura Health/SCL Health before the 2023 merger—operates as the Peaks Region of the Utah-based Intermountain Healthcare system, serving Colorado, Wyoming, and Montana. Intermountain had a $370 million national operating profit in 2024 (2.2% margin), though the Peaks Region specifically reported operating losses, losing approximately $156 million from operations (an improvement from $227 million in losses in 2023). Colorado facilities include AdventHealth hospitals and former Centura Catholic facilities operating under CommonSpirit Health.
Specialties We Serve in Colorado
Each specialty page dives into the specific billing challenges and our approach. Visit our Specialties to explore the one most relevant to your practice.
Why Colorado Providers Choose Happy Billing
- RAE-specific credentialing and contracting for all seven Colorado regional accountable entities
- CHASE compliance support for hospital-based providers subject to provider fee assessments
- Health First Colorado 2025 coverage expansion billing (undocumented pregnant women and children)
- Work requirement readiness planning for January 2027 implementation
- UCHealth, HCA HealthONE, and Intermountain Health network billing experience
- CICP uncompensated care billing support for safety-net and FQHC providers
Colorado Medical Billing FAQs
What is the CHASE fee and how does it affect Colorado hospital billing?
The Colorado Healthcare Affordability and Sustainability Enterprise (CHASE) assesses a provider fee on Colorado hospitals and uses the collected funds to leverage federal Medicaid matching dollars, generating approximately $494.5 million in increased hospital reimbursements annually. Hospitals must pay the CHASE fee and comply with CHASE reporting requirements, but benefit from significantly higher Medicaid reimbursement rates in return.