CO APCD Out-of-Network

During the 2019 Colorado legislative session, House Bill 19-1174 was passed to help protect patients from surprise out-of-network (OON) bills. The bill identifies provider reimbursement requirements for out-of-network emergency and non-emergency visits. The Colorado All Payer Claims Database (CO APCD) is identified in the bill as a data source to provide statewide and geographic commercial allowed (paid) amounts. During the summer and fall of 2019, Center for Improving Value in Health Care (CIVHC) collaborated with the Division of Insurance (DOI), providers, and payers to determine how to most accurately analyze and provide information from the CO APCD to support implementation of the bill. The first data sets were provided publicly in January 2020 and are updated on an annual basis.

Resources Related to HB 19-1174

• To access the data sets with allowed amounts for the most recent year, visit the Division of Insurance (DOI) Out-of-Network webpage: https://www.colorado.gov/pacific/dora/out-network-health-care-provider-reimbursement
• CO APCD OON Data Supporting Documents:
  • CO APCD Allowed Amounts Methodology & Details 2022 Service Dates (Issued December 2023)
  • CO APCD Out of Network Fee Schedule FAQs, December 2023 
  • Colorado Zip Code and County Crosswalk to Colorado DOI Region

Please contact CIVHC staff at ColoradoAPCD@civhc.org if you have additional questions.