We work your aged and denied claims against Colorado's own payer rules, inside the EHR you already use, and we are paid on what comes back.
“I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.”
Not sure where your balances stand? Start with a free audit.
Colorado payers
A Colorado practice is paid by Medicare through Novitas, by Health First Colorado, by commercial carriers the state regulates, by self-funded employer plans it doesn't, and by TriWest for TRICARE and VA patients. Each runs its own clock. Aged AR is recovered by working each balance against the rule that actually governs it.
Colorado's Part A and Part B claims go to Novitas Solutions, the Jurisdiction H contractor. CMS re-awarded Novitas the contract in June 2026. Claims must be filed within 12 months of the date of service. The same contractor pays claims in Texas, the other big state in Jurisdiction H.
Source: CMS, JH award, June 2026 · 42 CFR 424.44
Colorado's Medicaid program is run by HCPF, and who pays a claim depends on the member's plan and region:
Source: HCPF Provider News, June 2025 · HCPF, ACC Phase III · HCPF, plans by region
Source: HCPF FAQ, timely filing · HCPF billing training, Aug 2026
Clean claims must be paid, denied or settled within 30 days of receipt if filed electronically, or 45 days otherwise. Late clean claims carry 10% annual interest on the allowed amount, and a claim still unresolved 90 days after receipt adds a 20% penalty. An electronic claim is presumed received on the date of electronic verification of receipt, which the carrier or its clearinghouse must send within one business day.
The statute binds carriers the Division of Insurance regulates. Self-funded employer plans are not subject to Colorado insurance law. The receipt rule and the request steps are in how to claim Colorado prompt-pay interest.
Source: C.R.S. 10-16-106.5 · Colorado DOI, self-funded plans
For out-of-network care at an in-network facility, and out-of-network emergency care, the carrier pays the provider the greater of 110% of its median in-network rate for the service in that area or the 60th percentile of in-network rates from the Colorado All Payer Claims Database, which CIVHC publishes each year. That is payment in full apart from the patient's cost sharing, and the provider can request state arbitration within 90 days of payment.
The No Surprises Act defers to this: CMS treats Colorado's rules as a specified state law for insured plans. Self-funded plans generally follow the federal process.
Source: C.R.S. 10-16-704 · Colorado DOI · CMS letter, Colorado · KFF
Colorado is in the TRICARE West Region and VA Community Care Network Region 4, both run by TriWest. The 2025 TRICARE contractor change left some practices with unpaid TriWest claims.
Source: TriWest, TRICARE West · TriWest, VA CCN
The Division of Insurance lists six carriers selling individual plans for 2026: Anthem, Cigna, Denver Health, Kaiser Permanente, Rocky Mountain Health Plans and Select Health.
Source: Colorado DOI, July 2025
Engagement
The method is the same everywhere; see how AR recovery works. What changes in Colorado is how Medicaid claims are sorted and routed, and which commercial payments are owed more. We work remotely, inside the EHR you already use.
Health First Colorado balances are sorted by days since the date of service and days since the last remittance, so no claim past 365 days drops out of its 60-day chain.
Behavioral health goes to the member's RAE; physical health goes to HCPF fee-for-service or to the member's managed care plan.
Clean claims paid after 30 days (electronic) or 45 days (other) are flagged for 10% annual interest, and claims left past 90 days for the 20% penalty. The clearinghouse acknowledgment is kept as the receipt date.
Claims from out-of-network providers at in-network facilities are priced against the HB19-1174 floor, and short payments are queued for arbitration inside the 90 days.
Comparison
A process comparison drawn from one engagement outside Colorado. Not a record of a Colorado practice and not a promise of outcome.
| Area | Before | With Quilven |
|---|---|---|
| Rejection ownership | The rejection queue belonged to no one, and rejected claims sat for most of a year. | Rejections are worked within four to five days, while each claim can still be corrected and refiled. |
| Coordination of benefits | Other coverage was never updated with the patient, so the same claims kept denying. | Other insurance is confirmed with the patient, and Medicaid claims with a commercial primary are billed inside 365 days, which has no extension. |
| Payer routing | Claims went to a parent plan when a subsidiary with its own claims unit was the payer. | Health First Colorado claims go to HCPF fee-for-service, the member's RAE or the member's managed care plan, as the plan assignment requires. |
| Eligibility | Patients were seen on coverage that had ended, and the claims went out anyway. | Eligibility and plan assignment are checked before the visit, and retroactive eligibility claims go in within 60 days of the load letter. |
| Member and group IDs | One mistyped member ID stayed in the record for months. | Demographic fields are matched to the payer's record before the claim is sent. |
| Lab claim attribution | The group NPI sat where the ordering physician's belonged, and the CLIA level did not match the code. | The ordering physician's NPI is in box 17 and the CLIA level fits the code billed. |
| Modifiers | Waived tests went out without QW, and 25, 59 and RT were missing where they applied. | Modifiers are checked by code family before the claim goes out. |
| Timely filing | Rejections surfaced months later, with no proof the claims had ever been filed. | Medicaid claims past 365 days are resubmitted inside each 60-day window with the previous ICN, and proof of submission is kept. |
Which of these applies to your claims is a question the audit answers.
Deadlines
A Colorado claim is recoverable while its window is open, or if you can prove it was filed on time. For Health First Colorado, that proof is an unbroken chain: the original claim inside 365 days, then each resubmission inside 60 days of the last remittance. A claim past every window, with no proof of timely submission, is a write-off. See which Colorado claims are still workable.
| Rule | Deadline | Source |
|---|---|---|
| Medicare | 12 months from date of service | 42 CFR 424.44 |
| Health First Colorado | At least 365 days from date of service | HCPF timely filing FAQ |
| Health First Colorado, past 365 days | Resubmit within 60 days of the last remittance or returned claim, citing the previous ICN | HCPF billing training |
| Medicaid with other insurance | 365 days, no extension | HCPF timely filing FAQ |
| Medicare crossover, past 365 days | 120 days from the Medicare EOB | HCPF billing training |
| Retroactive member eligibility | 60 days from the Department's load letter, attached to the claim | HCPF billing training |
| Commercial clean claims | Paid in 30 days (electronic) or 45 (other); 10% annual interest after; 20% penalty at 90 days | C.R.S. 10-16-106.5 |
| Out-of-network arbitration | Requested within 90 days of payment | C.R.S. 10-16-704(15) |
Last checked: 22 Oct 2026
You can run your claims against these deadlines in the browser, with no patient data.
Case study
One AR recovery engagement, at a family medicine practice in Minnesota, not Colorado. Shown for method. Individual results vary. One engagement is not a forecast.
The engagement covered 245 claims. No one had been assigned the rejection queue, and close to a year of rejections had collected there.
Found: an estimated $40,000 to $50,000 in billed charges, never worked.
The cause sat mostly at intake. Out-of-date coverage, mistyped member IDs and skipped eligibility checks produced 70% of the denials.
Some claims were past saving. A commercial payer's 90-day filing window had already closed on most of the affected claims, and without proof of submission there was no appeal to make.
Recovered: about $5,500, paid on 50 to 55 claims, mostly within 45 to 50 working days.
I appreciate the professionalism, the courtesy, the knowledge.
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
Pricing
Same pricing as every Quilven engagement, with nothing Colorado-specific. See how every Quilven service is priced.
12 to 15%
of the recovered amount
No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.
3 to 5%
of collections by monthly volume
A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.
$150 to $200
per payer application
$200 per application, or $150 each for 8 or more. Can be included in a custom package for billing clients. Payer and state fees are paid by the practice.
Fit
Recovery work does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.
This matters because the usual objection to outside AR help is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on your existing inventory rather than after a build-out.
What you do get is visibility. Apex is our client dashboard, and it shows in real time:
Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.
Company
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $200 per payer application.
The entry point is a free RCM audit. It takes 48 hours and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick. QUILVEN, LLC is registered in Wyoming, with its principal office at 1603 Capitol Ave, Cheyenne, WY 82001. Reach us at (202) 490-9406 or info@quilven.com.
Quilven has no Colorado office. Work for a Colorado practice is done remotely, inside the practice's own EHR.
Fit
Independent Colorado practices with 3 to 25+ providers that have Health First Colorado, commercial or out-of-network claims aging toward their deadlines, and no one with the time to keep each claim inside its window.
If the backlog is a one-time problem, you can clear an aged backlog in one project instead of an ongoing engagement.
It is not for hospitals billing facility claims.
At a glance
FAQ
Next step
The audit takes 48 hours and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.
Answer three questions below and book a line-by-line audit of your Colorado claims.
Where is the money leaking right now?
Pick the one that hurts most. We start there.
How old is your oldest unpaid claim?
A round number is fine. We verify it in the audit.
How big is the practice?
Just you, or a group. Either is welcome.
Last bit — where do we send the report?
No patient data. We only need aging totals to start.
(202) 490-9406 · info@quilven.com · Book 15 minutes
Your revenue cycle is run by named people with real credentials, not an anonymous queue. Named leads and their certifications are introduced during onboarding, with photos and direct contacts.
Owner
A long-time business owner who has built and run companies in recruitment and e-commerce before Quilven.
Client Partnerships Lead
Leads business development, working with U.S. healthcare providers and medical practices from first conversation to signed agreement.
Head of Growth
Runs Quilven's marketing, SEO and Google Ads. Full-time in SEO since 2022.
Client Solutions Director
Works with medical practices on denials, credentialing and full-cycle revenue cycle work. A registered nurse before moving into revenue cycle.
Behind every account
One person owns your account, knows your practice and is your single point of contact.
Coders holding CPC and COC credentials, with coding experience across the specialties we serve.
Provider enrollment and recredentialing, handled by people who work payers and panels every day.
Analysts who work aged AR and appeals on a set cadence, by code, until each claim resolves.