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CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.100 Medical Services Board

286 3. Department Memo Series 4. Uniform Service Coding Standards 5. Current Procedural Terminology (CPT) code set 6. Current Healthcare Common Procedure Coding System (HCPCS) 7. Current International Classification of Diseases (ICD)) C. Failure to comply may subject the Provider to authorized administrative actions, civil investigation, and criminal investigation. 8.130.80 INACTIVATING PROVIDER AGREEMENTS A. A Provider may have its Provider Participation Agreement inactivated and will no longer be able to bill for goods and services if any of the following occur: 1. The Provider’s license, certification, or accreditation has expired or is subject to conditions or restrictions. 2. The Provider has failed to complete Provider revalidation. 3. The Provider is no longer eligible to participate as a Medical Assistance Program Provider or breaches the Provider agreement. 4. There is a Change of Ownership. 5. The Provider’s business closes, or the business is nonoperational. 6. The Provider is deceased or retired. 7. The Provider is inactive and has not submitted any claims activity for 24 months. B. The Provider will be sent written notice thirty (30) days prior to the inactivation, unless otherwise required by federal or state statute, regulation, or rule. 1. The notice will detail the reason for the inactivation. 2. The notice will give the Provider the opportunity to dispute the inactivation.

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Page 286

Official source

CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.100 Medical Services Board

286 3. Department Memo Series 4. Uniform Service Coding Standards 5. Current Procedural Terminology (CPT) code set 6. Current Healthcare Common Procedure Coding System (HCPCS) 7. Current International Classification of Diseases (ICD)) C. Failure to comply may subject the Provider to authorized administrative actions, civil investigation, and criminal investigation. 8.130.80 INACTIVATING PROVIDER AGREEMENTS A. A Provider may have its Provider Participation Agreement inactivated and will no longer be able to bill for goods and services if any of the following occur: 1. The Provider’s license, certification, or accreditation has expired or is subject to conditions or restrictions. 2. The Provider has failed to complete Provider revalidation. 3. The Provider is no longer eligible to participate as a Medical Assistance Program Provider or breaches the Provider agreement. 4. There is a Change of Ownership. 5. The Provider’s business closes, or the business is nonoperational. 6. The Provider is deceased or retired. 7. The Provider is inactive and has not submitted any claims activity for 24 months. B. The Provider will be sent written notice thirty (30) days prior to the inactivation, unless otherwise required by federal or state statute, regulation, or rule. 1. The notice will detail the reason for the inactivation. 2. The notice will give the Provider the opportunity to dispute the inactivation.