ColoradoPAR: Health First Colorado Prior Authorization Request Program

Provider Updates

Attention Physician Administered Drug (PAD) Providers: When entering a PAD PAR into Kepro's system Atrezzo, please note that the "Servicing Provider" in Atrezzo is actually referencing the "Billing provider". And then the "Rendering Provider" in Atrezzo can also be known as the "Servicing Provider."

Marshall Wildfire Response: Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro)

In response to the devastating Marshall wildfire in Boulder County on December 30, 2021, the Department has worked with the fee for service Utilization Management (UM) Vendor, Kepro, to implement temporary changes to address urgent needs of Health First Colorado Members affected by the wildfire. If a Provider is working with a member that needs a PAR to address destroyed or missing equipment or supplies as a result of the wildfire and/or subsequent evacuations, the Provider may request an expedited PAR by selecting “expedited” as the request type through Kepro’s PAR system, Atrezzo.

When submitting an expedited PAR, the Provider will be prompted to answer whether this is due to the December 30, 2021 wildfire, and upon answering yes, the case will be routed to be reviewed as an expedited review. The Provider will need to submit documentation or a note in the case identifying this as a replacement or rental due to the wildfires to ensure prompt response, with minimal documentation required. Additionally, if available, please include the PAR number or case ID of the previously approved PAR. As a reminder, all expedited cases are reviewed in less than 4 Business Hours.

If there are any questions about this process please contact Kepro Customer Service at (720) 689-6340 or email the UM inbox at hcpf_UM@state.co.us.

Attention Physician Administered Drug Providers: Kepro will officially begin accepting prior authorization requests (PARs) for physician-administered drugs (PADs) on Tuesday, January 18, 2022.  However, if you have a patient receiving a PAD on either Tuesday (January 18^th) or Wednesday (January 19^th) which requires a prior authorization, Kepro will accept and review these PARs beginning Friday, January 14, 2022.   All other requests will need to be initiated beginning Tuesday, January 18, 2022. All PAD PA procedures and clinical criteria may be found on Appendix Y: Physician Administered Drug Medical Benefit Prior Authorization Procedures and Criteria. Providers will be required to follow all General Provider and PAD billing policies found in the PAD billing manual located on the Billing Manuals web page.

Kepro will be completing PAD prior authorization requests and will be offering live system administrator training, Atrezzo system training, PAD benefit specific training, and question and answer sessions for PAD providers to address any Atrezzo system or benefit specific questions. Providers can sign up for training by visiting the Kepro Training Information web page.

Attention PDN and PLTHH Providers: Updated guidance has been posted regarding prior authorization requests for Home Health Agencies providing Private Duty Nursing and Pediatric Long Term Home Health. Information can be found in Operation Memo 21-081, located on the 2021 Memo Series Communication web page under 2021 Operational Memos.

Title 19 Eligibility Issue: We are aware of a member eligibility issue where providers confirm a member is eligible for Title 19 but when they try to submit for prior authorization in Kepro's portal, Atrezzo, they are receiving an error stating "No Title 19 Coverage". We are actively working on resolving this issue as soon as possible. In the interim, please email the UM inbox hcpf_um@state.co.us for information on an alternative submission method.

ATTENTION PROVIDERS: Please review Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022

In response to the current COVID-19 surge that Colorado is experiencing, the diagnostic imaging codes below temporarily do not require prior authorization effective for dates of service on and after November 1, 2021. This will remain in effect until further communication from the Department. 

• 74150  

• 74160  

• 74170  

• 74174  

• 74175  

• 74176  

• 74177  

• 74178 

• 72192  

• 72193  

• 72194  

PDN/PLTHH PARs: A 10 month 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 November 1, 2021.  Kepro will be offering additional live benefit specific training sessions and question and answer sessions for PDN and PLTHH to address Atrezzo system or benefit specific questions.  Registration information, recorded webinars and slides are located on our Provider Training web page.

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.

Atrezzo Account Reactivation: Atrezzo will deactivate a Provider’s user account if the account has not been used in the past ninety days for security purposes. Kepro is currently working on developing an email alert that will be sent to the Atrezzo user’s registered email address warning that their account is about to be deactivated due to no activity. The notice of account deactivation will occur when the provider attempts to login to the Atrezzo account.  Providers can call Kepro's customer service by calling (720) 689-6340 or emailing coproviderissue@kepro.com to reactivate Atrezzo accounts.

Provider Reporting Tool Located in Atrezzo is Now Available: After receiving feedback from Health First Colorado providers, Kepro has developed a provider reporting tool available within Atrezzo so providers can easily track the statuses and determinations of all cases. Information on how to access and use the report can be found here.

Synagis®: Effective August 17, 2021, Health First Colorado (Colorado’s Medicaid Program) began accepting Prior Authorization Requests (PARs) for Synagis®. Providers who are administering Synagis® in the provider’s office or clinic will submit prior authorization through Kepro’s provider portal, Atrezzo. Please review the Synagis® Provider Bulletin for additional information.

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.