Colorado § 25.5-4-204 - Automated medical assistance administration.

§ 25.5-4-204. Automated medical assistance administration.

(1) The general assembly hereby finds and declares that the agency responsible for the administration of the state's medical assistance program would be more effective in its ability to streamline administrative functions of program administrators and providers under the program through the implementation of an automated system that will provide for the following:

(a) Electronic claim submittals;

(b) Online eligibility determinations;

(c) Electronic remittance statements;

(d) Electronic fund transfers; and

(e) Automation of other administrative functions associated with the medical assistance program.

(2) Therefore, the general assembly declares that it is appropriate to enact legislation, as set forth in subsection (3) of this section, that authorizes the state department to develop and implement an automated system for processing claims and payments under the medical assistance program, as well as for other administrative functions associated with the program.

(3) The executive director of the state department shall develop and implement an automated system through which medical assistance claims and payments and eligibility determinations or other related transactions may be processed. The system shall provide for the use of automated electronic technologies. The automated system may be implemented in phases if deemed necessary by the executive director. The automated system shall be implemented only after the executive director determines that:

(a) Technology is available and proven to perform satisfactorily in a production environment;

(b) Adequate financing is available to facilitate the implementation and maintenance of the system. Financing may include, but is not limited to, federal funds, appropriations from the general fund, provider transaction fees, or any other financing mechanisms which the state department may impose, and grants or contributions from public or private entities.

(c) The system has been successfully installed and fully tested; and

(d) Adequate provider training has been provided for an orderly implementation.

(4) County-level fraud functions must be administered using the centralized member integrity service, established in section 25.5-1-210, or shared services, as defined in section 26-1-802.

Source: L. 2006: Entire article added with relocations, p. 1822, § 7, effective July 1. L. 2026: (4) added, (HB 26-1429), ch. 374, p. 2313, § 12, effective June 4.

Editor's note: This section is similar to former § 26-4-403.7 as it existed prior to 2006.

Cross references: For the legislative declaration in HB 26-1429, see section 1 of chapter 374, Session Laws of Colorado 2026.