PHP Claims Department

The goal of the PHP Claims Department is to ensure that claims be processed in a timely and accurate manner and that standard-reporting requirements are met. PHP is responsible for paying claims for the Colorado Department of Corrections (CDOC), Colorado Division of Youth Corrections (CDYC), and Mental Health Institute (MHI).

The Claims Department handles the following aspects of the claims process for our clients:

• Providing payment and denial notification to providers
• Handling of paper claims including retrieving, sorting, scanning and inventory control
• Submitting claims reporting to both our clients and providers
• Verification of pended claims including eligibility, authorizations, high dollar, and non-contacted
• Handling of Appeals and Grievances
• Readjustments of claims
• Providing Customer/Provider service, including claims status, denials and payment activity
• Submission of fee schedules into Plexis
• Reconciliation/reversal process for Providers

PHP processes all clean paper claims within 45 days of receipt, and within 30 days of receipt of clean electronic claims. Clean claims are defined as claims for eligible adult and youth state offenders that contain all the necessary information, and have a prior authorization on file.

Please click here for claims lookup.