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Colorado RAC

a service of HMS

Colorado RAC

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

Provider Billing Manual

Colorado RAC Scope:

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

Exit Conference Process

  • If an Exit Conference is desired, Providers must call HMS Provider Services within ten (10) days of the Medical Records Request Letter to request an Exit Conference.
  • HMS cannot guarantee the processing of late or misrouted requests for an Exit Conference.
  • Upon receipt of a timely Exit Conference request, HMS will contact the provider to schedule the exit conference. Please note that Exit Conferences are scheduled to occur after the completion of the medical record reviews.
  • HMS will supply preliminary findings to the provider two (2) days prior to the Exit Conference.
  • Upon completion of the Exit Conference, the provider has five (5) business days to mail in additional records/information.
  • HMS reviews the any additional documentation within 20 calendar days of receipt.
  • Formal findings letters are mailed to providers thereafter.

Electronic Submission

  • HMS prefers medical records be submitted electronically through the Provider Portal.

Mailing in Medical Records

  • Providers may mail in hard copies of medical files, or fax copies to: 1-855-278-3479.
  • HMS prefers medical records be submitted electronically through the Provider Portal.
  • Please mail records or CDs or DVDs to the address below:

HMS – Colorado Recovery Audit Services
5615 High Point Drive
Mail Stop 200-CO
Irving, TX 75038

  • For password, protected DVD or CDs to ensure proper processing email the password to CORAC@hms.com. Please include the following in the email:
    • Letter Reference number (example: ) and/or Internal Control Number (ICN) from the Medical Records Request Letter
    • The password
    • Any CD label information
    • Tracking information to include the carrier and tracking ID
  • HMS recommends that preferred provider point(s) of contact are loaded into the HMS Provider Portal. In the event of a damaged CD or incomplete record, HMS will attempt to contact the provider.  Please see the Provider Portal training for information on how to add/update provider contacts.  

SFTP

Providers may also request a Secure File Transfer Protocol (SFTP) be set up for delivering electronic medical records. Please contact HMS Provider Relations with any SFTP requests.
  • Providers may request an extension of the Medical Records due date. Requests must be made in writing and received by HMS within fifteen (15) days of the date of the Medical Records Request Letter.  The written request for extension must include the reason for the request and the length of the requested extension.   Extension requests must be mailed to:

HMS – Colorado Recovery Audit Services
Medical Records Extension Request
5615 High Point Drive
Stop 200-CO
Irving, TX 75038

Informal Reconsideration Process

  • Providers may request an Informal Reconsideration.
  • Informal Reconsiderations must be received within thirty (30) days of the date in the Adverse Action Letter.
    • Informal Reconsiderations must be mailed to:

HMS – Colorado Recovery Audit Services
Informal Reconsideration Request
5615 High Point Drive
Stop 200-CO
Irving, TX 75038

  • Informal Reconsiderations must comply with the Code of Colorado Regulations requirements:

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.

Contact Information

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