ColoradoPAR Program Background
ColoradoPAR is the Health First Colorado (Colorado's Medicaid program)utilization management (UM) program. A third-party vendor, eQHealth Solutions, reviews Prior Authorization Requests (PARs) to ensure items and services requested meet medical necessity guidelines and are compliant with Federal regulations and Health First Colorado's policies.
What are the Goals of the ColoradoPAR Program?
- Improve health outcomes of Health First Colorado members
- Ensure appropriate utilization of state resources by eliminating duplicative and unnecessary services, and
- Allow providers to easily track the status of their prior authorization requests (PARs) using a web portal, rather than a paper process.
Key activities performed by the ColoradoPAR Program
- Prior Authorization Requests (PARs): Providers request authorization for services before providing certain services. The ColoradoPAR vendor reviews the request to determine if services are medically necessary according to established criteria and guidelines. The ColoradoPAR Program reviews PARs for the following categories of services and supplies:
- Pediatric Behavioral Therapy
- Diagnostic imaging
- Durable medical equipment (DME)
- Inpatient out-of-state admissions
- Medical services (including select restorative, back, transplant, bariatric surgeries)
- Physical and occupational therapy
- Select Molecular Testing
- Pediatric long term home health (LTHH)
- Pediatric Personal Care Services (PCS)
- Private Duty Nursing (PDN)
- Speech Therapy: Habilitative and Outpatient
The Inpatient Hospital Review Program (IHRP) is Health First Colorado's program to review all Inpatient Hospital Admissions to ensure appropriate care is provided in compliance with federal/state rules and regulations. The IHRP will assist in ensuring that care is provided at the appropriate setting, duration and time as well as ensure there aren't other additional appropriate alternative services available. The program will also assist with providing improved care coordination between the Colorado Hospitals and the Regional Accountable Entities (RAEs). For additional information on IHRP, please visit the IHRP Provider page. As part of this program, Hospitals will be following the processes below and submit PAR's directly to eQHealth Solutions, via eQSuite:
- Prior Authorization Requests (PARs) or Admission Reviews - Hospitals will be submitting based on established timelines before or shortly after admission for all services excluding the following,
- Maternity and maternity
- Members with Medicaid as a secondary payer
- Admissions to long term rehabilitation facilities
- Capitated behavioral health services
- Concurrent Review (or Continued Stay Review) - If a Health First Colorado member is still admitted as an inpatient on Day 4 and has one or more of the following conditions, Sepsis, Pneumonia, NICU and Acute Respiratory Failure, they will receive Complex Case Management to help to facilitate additional care coordination when appropriate.
Please note: For the above categories, all PARs for clients age 20 and under are reviewed according to EPSDT guidelines.
*** ColoradoPAR does not review services for Behavioral Health Services, Dental/Orthodontia, Pharmacy, and Transportation. Please see the Provider Help page for additional information on these services.
Who Performs UM activities for Health First Colorado?
eQHealth Solutions was selected by the Department to provide utilization management services beginning September 1, 2015. eQHealth Solutions reviews and authorizes prior authorization requests (PARs) for the ColoradoPAR Program.
ColoradoPAR Provider Portal: eQSuite
eQSuite is eQHealth Solutions' proprietary, web-based, HIPAA-compliant prior authorization request system, which offers providers 24/7 accessibility to the information and functions providers need.
Providers must complete and submit the Request for eQSuite Access form. A logon must be assigned and a system administrator designated for each individual provider number. The system administrator assigns and maintains logons for all eQSuite users assigned to enter PARs under that number. The eQSuite Administrator Guide can be found on the Colorado PAR website. For additional information on ColoradoPAR, please see the ColoradoPAR website
What other Health First Colorado services is eQHealth Solutions responsible?
eQHealth Solutions also reviews eligibility for two waivers: Children's Home and Community-Based Services (CHCBS) and Children's Extensive Services (CES). Additionally, eQHealth Solutions is responsible for reviewing Over Cost Containment (OCC). For more information about the CHCBS waiver please review the Health First Colorado CHCBS Information page, and for additional information about CES please review Health First Colorado CES Information page.
Where can I get additional information and assistance about the ColoradoPAR program and/or eQHealth Solutions?
More information on any of the services performed by the Department's UM Vendor, eQHealth Solutions, can be found by visiting the ColoradoPAR Provider Website or by contacting the ColoradoPAR Provider Helpline at 1-888-801-9355.
If you have questions for the Department about the UM Vendor/Activities or the Colorado PAR Program you can email hcpf_UM@state.co.us.
If you have questions or concerns about the Inpatient Hospital Review Program (IHRP) you can email email@example.com.