The Recovery Audit Contract Project is a federally mandated audit and recovery program, pursuant to Section 6411 of the Patient Protection and Affordability Care Act of 2010. The Colorado Department of Health Care Policy and Financing (the Department) has contracted with Health Management Systems, Inc. (HMS) as the Health First Colorado Recovery Audit Contractor (RAC), who is authorized to conduct post-payment reviews of claims submitted for fee-for-service and managed care services on behalf of the state.
As the Health First Colorado RAC, HMS® works to identify under and over payments and assist the Department in recovering any overpayments made to the provider through Health First Colorado.
This website provides information relevant to the work to be completed by HMS on behalf of the Department for the RAC Project. It is intended to support the Department in achieving its mission to reduce improper Health First Colorado payments and to support providers with education and resources.
For state and federal statutes and regulations, refer to the following links and citations which further outline the Department’s authority and the provider’s responsibilities with regards to the Health First Colorado RAC program:
Code of Colorado Regulations:
10 CCR 2505-10 8.015.8.B;
10 CCR 2505-10 8.076.2.A-D;
10 CCR 2505-10 8.076.3A;
10 CCR 2505-10 8.130.2A
Colorado Revised Statutes:
CRS 25.5-4-301
Code of Federal Regulations:
42 CFR Part 455, Subpart F
42 CFR 433.316
The RAC lookback period is 7 years (84 months) from the Medicaid Paid Date of the claim. All claim and provider types are included. State Plan Amendment CO-16-003
HMS – Colorado Recovery Audit Services
5615 High Point Drive
Mail Stop 200-CO
Irving, TX 75038
HMS – Colorado Recovery Audit Services
Medical Records Extension Request
5615 High Point Drive
Stop 200-CO
Irving, TX 75038
HMS – Colorado Recovery Audit Services
Informal Reconsideration Request
5615 High Point Drive
Stop 200-CO
Irving, TX 75038
Please see 10 C.C.R. 2505-10, Section 8.050.6, Informal Reconsiderations and Appeals of Overpayments Resulting from Review or Audit Findings, for Medicaid rules regarding a request for an Informal Reconsideration.
Inquiry Type | Appropriate Contact | Contact Information |
Exit Conference Request | HMS Provider Services | 1-877-640-3419 |
Questions about HMS Provider Portal | HMS Provider Services | 1-877-640-3419 |
Rebilling Help | DXC Provider Services | 1-844-235-2387 |
Address updates in HMS Provider Portal | HMS Provider Services | 1-877-640-3419 |
Claim/Review Status Questions | HMS Provider Services | 1-877-640-3419 |
Providing a Password for a CD or DVD | HMS Provider Services | CORAC@hms.com |
HMS Escalations | HMS RAC Account Management | CORAC@hms.com |
Medical Records Address | Mailed to HMS | HMS – Colorado Recovery Audit Services 5615 High Point Drive Mail Stop 200-CO Irving, TX 75038 |
Informal Reconsideration Request | Mailed to HMS | HMS – Colorado Recovery Audit Services Informal Reconsideration Request 5615 High Point Drive Stop 200-CO Irving, TX 75038 |
Medical Record Extension Requests | Mailed to HMS | HMS – Colorado Recovery Audit Services Medical records Extension Request 5615 High Point Drive Stop 200-CO Irving, TX 75038 |