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December 12, 2024

December spotlight: What happens when health care providers don’t certify a requested FAMLI claim

Colorado requires workers to get certification from a licensed health care provider for certain types of FAMLI leave. That makes health care providers critical when Colorado workers need to step away from work to care for themselves or a loved one. So what happens if a patient requests your certification, but you don’t respond?

When someone starts a FAMLI claim but doesn’t give us all the required information or certification, that claim is considered “pending” in the system for 60 days. 

In the case of a claim that requires a Serious Health Condition Form, the My FAMLI+ portal has a built-in five-day time limit for claims to be certified by the designated health care provider. If the provider doesn’t complete that form within the five days, the claimant gets a notification to either print the form and have a licensed provider complete it by hand, or change their provider in My FAMLI+ to send the digital form to another provider. 

However the form is submitted, the claim should be updated in the portal to indicate if a different licensed provider is being used to certify it.

(Remember that FAMLI rules do not allow a health care provider to certify a serious health condition for themselves or for a family member or for a condition that is outside their diagnostic scope.) 

Providers should be aware that their patients can’t receive FAMLI payments for time away from work until the FAMLI Division has a certified Serious Health Condition Form.   Any FAMLI claim that requires certification from a licensed health care provider is closed after 60 days if the FAMLI Division doesn’t receive a certified Serious Health Condition Form. Claimants are notified when this happens and given a chance to establish a good cause for keeping the claim open.

If you have any questions about a pending FAMLI certification request, our experts are standing by to help. Drop us a line at cdle_famli_info@state.co.us or give us a call at 1-866-CO-FAMLI (1-866-263-2654) Monday through Friday between 7:30 a.m. and 4:30 p.m. Mountain Time.

Include FAMLI in your after-visit summaries

After-visit summaries are super important for health care providers. They let patients know their next steps and give them crucial information about their health.

Now you can make those summaries even more valuable by letting your patients know about paid family and medical leave in Colorado. We encourage you to copy-and-paste the message below into your after-visit summaries: 

Did you know that nearly all workers in Colorado now qualify for paid leave to take care of themselves or a loved one with a serious health condition? Pregnancy qualifies as a serious health condition, and both parents are eligible to take up to 12 weeks to bond with a new child.  Find out more and get your claim started at famli.colorado.gov.

We also encourage you to print out our “What-Is-FAMLI” flyers in both English and Spanish. These flyers are a great introduction to FAMLI and will point your patients in the right direction to learn more.