ColoradoPAR: Health First Colorado Prior Authorization Request Program

UM Vendor Update

A phased in implementation of the prior authorization request (PAR) requirement for Private Duty Nursing (PDN) and Pediatric Long-Term Home Health (PLTHH) is to begin on September 1, 2021.  Kepro will be offering benefit specific training sessions for PDN and PLTHH and question and answer sessions to address Atrezzo system questions.  To register for training and view recorded Atrezzo system trainings visit the Kepro Provider Training Information website.

We are aware that there are some delays on PAR decisions during implementation of the new UM Vendor. The Department is working with Kepro to address this issue and ensure timely turn around on PAR decisions. Please reach out to hcpf_um@state.co.us with any escalated concerns.  

Kepro's Call Center is live and can be reached by calling (720) 689-6340.

Attention: Providers who need to modify a PAR that was completed by eQ should complete a change request form.

The latest communication on the UM Vendor transition can be found here.

eQ to Kepro Transition Timeline

Key dates for the eQ to Kepro transition

Current authorizations with end dates after May 1st will remain effective until the end date on the PAR so you can proceed with submitting claims as you usually do. Information on the process of making a modification to a PAR that was completed by eQ will be available soon and sent out via email and provider bulletin.

As a reminder from a previous communication, eQHealth's PAR portal, eQSuite®, will be available through May 31, 2021. Providers should ensure any necessary documentation, including clinical documentation and determination letters, have been downloaded from the portal on or before May 31, 2021. Kepro will have access to historical PAR data from the last 3 years, but the information and documentation will not be available to providers.

eQ to Kepro Transition Communication

The latest communication on the UM Vendor transition can be found here.

Emails

• Keystone Peer Review Organization Kepro Transition and Survey Results - March 25, 2021
• Training for New Prior Authorization Portal - March 11, 2021
• Training Information: New Utilization Management UM Vendor for Prior Authorizations - March 1, 2021
• New Utilization Management UM Vendor for Prior Authorizations - February 22. 2021

Bulletins

• Health First Colorado News and Updates (B2100461 - April 2021)
• Health First Colorado News and Updates (B2100460 - March 2021)
• Health First Colorado News and Updates (B2100459 - February 2021)

About Kepro

Kepro delivers care management and quality oversight solutions using clinical expertise and technology-driven solutions to improve quality and clinical outcomes for vulnerable populations. Kepro currently holds both Quality Improvement Organization (QIO) and QIO-like designations from CMS. Kepro is Utilization Review Accreditation Commission (URAC) accredited and licensed to perform reviews in every state. Kepro brings 30+ years of Medicaid and Medicare experience, serving 27 Medicaid agencies over more than 20 years. They are one of the largest and most experienced federal, state, and local government review vendors in the nation, supporting government programs for over one billion covered individuals since 1985.