State RegulationsCO specificDifficulty 3/5
A Colorado carrier makes a partial payment on a clean claim by day 45 while auditing the charges. Under C.R.S. § 10-16-106.5, the partial payment must be at least:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
C.R.S. § 10-16-106.5 permits charge-audit partial payments, but by day 45 a partial payment on a clean claim must be at least 85% of the contracted rate for participating institutional providers, and at least 60% of the amount due for nonparticipating providers. The carrier may audit, but it cannot use the audit to stall most of the payment.
Why the other options are wrong
- A) 60% is the floor for nonparticipating providers, not for participating institutional providers.
- C) 45% is not a charge-audit floor under the prompt-pay statute.
- D) 20% is far below the required 85% contracted-rate floor for participating institutional providers.
Memory hook
By day 45: 85% in-network institutional, 60% out.