Program/Services and Authorizing Agencies
The following list is a reference for identifying the agent authorized to perform prior authorization or peer review functions for Health First Colorado. Specific questions regarding prior authorization or peer review should be directed to the Authorizing Agent.
| Program/Services | Authorizing Agencies |
|---|---|
| Audiology services | |
| Cochlear implant repairs and supplies | The ColoradoPAR Program |
| Hearing aids | The ColoradoPAR Program |
| Hearing aid batteries and supplies | The ColoradoPAR Program |
| Behavioral Therapy | The ColoradoPAR Program |
| Contact lenses, under age 20 and under | The ColoradoPAR Program |
| Dental services | |
| Age 20 and younger | DentaQuest |
| Inpatient/surgery hospital care, all ages | DentaQuest |
| Non-routine, age 21 and older | DentaQuest |
| Oral maxillofacial surgery, age 21 and older | DentaQuest |
| Orthodontia | DentaQuest |
| Durable Medical Equipment | |
| Orthotics | The ColoradoPAR Program |
| Prosthetics | The ColoradoPAR Program |
| Power wheelchairs | The ColoradoPAR Program |
| Power scooters | The ColoradoPAR Program |
| Repairs/Modifications | The ColoradoPAR Program |
| All Others | The ColoradoPAR Program |
| EBI bone stimulator | The ColoradoPAR Program |
| Home and Community Based Services | |
| Brain Injury (HCBS-BI) | Single Entry Point (SEP)/ Case Management Agency (CMA) |
| Developmentally Disabled (HCBS-DD) | Developmental Disabilities Services – Community Centered Board |
| Supported Living Services (HCBS-SLS) | Developmental Disabilities Services- Community Centered Board |
| Children’s Extensive Support (CES) | Developmental Disabilities Services-Community Centered Board |
| Children’s Habilitation Residential Program (CHRP) | County Department of Human Social Services |
| Elderly, Blind, and Disabled (HCBS-EBD) | Single Entry Point/ Case Management Agency |
| HCBS - Community Mental Health Supports(CMHS) | Single Entry Point/ Case Management Agency |
| Spinal Cord Injury (HCBS – SCI) | Single Entry Point/ Case Management Agency |
| Colorado Choice Transitions (CCT) | Single Entry Point/ Case Management Agency |
| Children with Life Limiting Illness (CLLI) | Single Entry Point/ Case Management Agency |
| Home Health Services | |
| Extraordinary Home Health (members age 17 years and younger) |
The ColoradoPAR Program |
| Extraordinary Home Health w/o Waiver (members age 18, 19, 20) |
The ColoradoPAR Program |
| Long Term Home Health (members age 18 years and older) |
*Single Entry Point/ Case Management Agency
|
| Long Term Home Health w/ HCBS waiver (members 21 and older) |
**Community Centered Boards |
| Long Term Home Health (members aged 17 years and younger) |
The ColoradoPAR Program CHCBS- Children’s Home and Community Based Services |
| Long Term Home Health w/ or w/o HCPF waiver (members age 21 and older) |
*Single Entry Point/ Case Management Agency |
| Long Term Care diversion to HCBS | Single Entry Point/ Case Management Agency |
| Medical supplies | The ColoradoPAR Program |
| Medical/Surgical services | The ColoradoPAR Program |
| Mental Health Services including psychiatric hospitalization | Regional Accountable Entities (RAE) |
| Occupational/Physical Therapy (over 24 units of service) | The ColoradoPAR Program |
| Oral surgery, age 21 and younger | DentaQuest |
| Organ transplantation | The ColoradoPAR Program |
| Personal Care | The ColoradoPAR Program |
| Substance Use Disorder | Regional Accountable Entities (RAE) |
| Vision | The ColoradoPAR Program |
| Out-of-state Non-emergency surgical services |
The ColoradoPAR Program |
| Private duty nursing | The ColoradoPAR Program |
| Prescription drugs | Prescription Drug Card System (PDCS) |
| Reconstructive surgery | The ColoradoPAR Program |
| Residential Treatment Centers | County Department of Human Social Services |
| Transportation | Please refer to the Transportation Billing Manuals |
Appendix D Revisions Log
| Revision Date | Appendix | Made by |
|---|---|---|
| 12/10/2016 | Update for new Fiscal Agent | HPE (now Gainwell) |
| 12/27/2016 | No changes required in Colorado iC Stage II Provider Billing Manual Comment Log v0_2.xlsx | HPE (now Gainwell) |
| 1/10/2017 | Updates based on Colorado iC Stage II Provider Billing Manual Comment Log 0_3.xlsx | HPE (now Gainwell) |
| 1/19/2017 | Updates based on Colorado iC Stage II Provider Billing Manual Comment Log v0_4.xlsx | HPE (now Gainwell) |
| 1/26/2017 | Updates based on Department 1/20/2017 approval email | HPE (now Gainwell) |
| 5/22/2017 | Updates based on Fiscal Agent name change from HPE to Gainwell | Gainwell |
| 6/25/2018 | Updated BHO with RAE | HCPF |
| 3/31/2021 | Removed reference to CWA as discontinued | HCPF |
| 6/8/2022 | Converted PDF to web page | HCPF |