Appendix D

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
  • HCBS - Brain Injury (BI)
  • HCBS - Children with Autism (CWA)
  • HCBS - Children with Life Limiting Illness (CLLI)
  • HCBS - Colorado Choice Transitions (CCT)
  • HCBS - Community Mental Health Supports (CMHS)
  • HCBS - Elderly, Blind, and Disabled (EBD)
  • HCBS - Spinal Cord Injury (SCI)
**Community Centered Boards/ Case Management Agency
  • HCBS - Children's Extensive Services (CES)
  • HCBS - Development Disabilities (DD)
  • HCBS - Supported Living Services (SLS)
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