Colorado RAC Stakeholder Comments, Suggestions, & Requests Form
*Required
*Required
You have the option to provide your orginizational title.
If you are a provider you have the option to provide the name of your location, facility office.
If your facility or office is part of a larger hospital system you have the option to provide the name of your hospital system.
If you are a representative of a provider association you have the option to provide the name of your association.
If you are an attorney or representative you have the option to provide the name of your firm.
Please provide as much information as you need here so we have the details to address your request.
If you have a document you would like to upload, please do so here.
Please DO NOT upload any thing with protected health information (PHI)