ColoradoPAR: Health First Colorado Prior Authorization Request Program

PARs Pause Extended Through March 2024 for Series of Services and Therapies

In January, the Department of Health Care Policy and Financing (the Department) temporarily paused prior authorizations request (PAR) requirements for a series of pediatric long-term home health services and home health therapies until June 1, 2022. Those included PARs for pediatric long-term home health Certified Nursing Assistant (CNA) services, and home health physical therapy, occupational therapy, and speech language pathology therapy services.  

Effective Feb. 28, 2022, the pause on the requirement to submit a PAR will extend until at least March 2024 and will now include: 

• Pediatric long-term home health CNA services 

• Pediatric long-term home health therapies: occupational therapy, physical therapy, and speech-language pathology therapy 

• Pediatric long-term home health intermittent skilled nursing 

The two-year pause allows the Department and partners time to robustly engage with stakeholders, train providers on operational changes, evaluate benefit policy, and notify Health First Colorado (Colorado’s Medicaid program) members before the pause is lifted. This also gives the Department time to ensure full compliance with federal and state policy while keeping Health First Colorado members and their needs front and center. 

The Department is now collaborating with our utilization management vendor, Kepro, to implement operational changes supporting the extended pause. We will communicate and issue policy changes to Health First Colorado members, providers and other stakeholders over the coming days. The Department appreciates the engagement from Health First Colorado providers and members while we work on this important process during the next two years. Continue visiting hcpf.Colorado.gov/par-updates for more information and updates. 

Kepro is not completing prior authorization requests for Adult Long Term Home Health services. Please refer to the Adult Long Term Home Health Services webpage for additional information.

Attention Physician Administered Drug (PAD) Providers: When entering a prior authorization request (PAR) for a physician-administered drug (PAD) in Kepro’s Provider Portal, Atrezzo, it is important to note that the servicing provider is the billing provider.

If entering the rendering provider as the servicing provider, there may be instances where the rendering provider type is producing a PAR submission error. Please ensure the billing provider is entered on the PAR as the servicing provider to successfully submit the PAR and to avoid subsequent PAD claims processing issues.

For any approved PAR on file in which the billing provider was not entered as the servicing provider, please complete the following steps for the pertinent scenario to ensure the information on the PAR is accurate and to avoid PAD claims processing issues.

1. There has been at least one claim billed on the PA
   1. Submit a new PA request
   2. Add a note to include:
      1. A description of the error
         1. Previous PA was approved with rendering provider listed as the servicing provider
      2. Your request to end-date the previous PA and include the case ID
2. There have been no claims billed on the PA
   1. File a revision request on the submitted PAR in Atrezzo
      1. Follow the instructions for How to Make Revisions to Submitted Request