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No Surprises Act IDR in Colorado

Colorado: state payment standard and federal IDR for out-of-network providers

Colorado uses a formula-based payment standard for surprise bills. Which out-of-network claims go to federal IDR instead, and how we file for provider groups.

Colorado was an early hybrid state

Colorado's 2019 law was one of the first to combine a payment standard with a limited challenge path. For state-regulated coverage, out-of-network payment for surprise bills is set by a state formula tied to in-network rates, with room to contest an amount that's insufficient given the complexity and circumstances of the services.

Self-funded plans are federal. ERISA self-funded employer coverage isn't regulated by Colorado, so those claims go through the federal IDR process — a genuine arbitration where the QPA is one factor among several, not the ceiling.

What we do for Colorado groups

  • Screen each remit for plan type before deciding whether a dispute is worth filing
  • Run the federal process end to end: open negotiation, initiation, IDR entity selection, offer and rationale
  • Batch federal disputes by payer and code
  • Track payment after determination and escalate when awards go unpaid

We verify the current state standard and the applicable process before filing.

Which process applies to your claims?

Send 90 days of out-of-network remits. We'll tell you claim by claim: federal IDR, state process, or not disputable — plus what comparable disputes have paid.

Free claims review

Related

How federal IDR works
IDR eligibility checklist
Deadline calculator
Other states

Find out what your out-of-network claims are actually worth.

Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.

Request a free eligibility review