ColoradoPAR: Health First Colorado Prior Authorization Request Program

UM Vendor Update

Keystone Peer Review Organization (Kepro) will be the new utilization management (UM) partner for Health First Colorado (Colorado's Medicaid Program) as previously announced in the February 2021 Provider Bulletin (B2100459). Kepro is replacing eQHealth Solutions, Inc. and will begin to receive Prior Authorization Requests (PARs) for all Fee For Service Health First Colorado Benefits that eQHealth Solutions, Inc. currently authorizes on May 1, 2021.

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

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.

Provider Survey

Providers are invited to complete a provider survey to share opinions on provider portal functionality and training. All feedback will be considered to help make decisions regarding the UM program.

Provider Training Information

Sign up for Kepro's 1.1 System Administrator Training

Sign up for Kepro's 2.1 and 2.2 Provider Portal, Atrezzo, User Training

Coming Soon: Kepro's Benefit Specific Training

Attention DMEPOS Suppliers: The 'multiple line item' policy instruction announced in the January 2021 Provider Bulletin is delayed until further notice due to operational issues. Providers are to continue coding claims and Prior Authorization Requests in their current manner. We apologize for the confusion.

The Department has announced the intent to award the Utilization Management (UM) contract to Keystone Peer Review Organization (KEPRO). Kepro will replace eQHealth Solutions, Inc as the UM Vendor in Spring of 2021. The go-live date for Kepro has not yet been finalized, but additional announcements will be posted to this website and sent out via Provider Bulletin. Please ensure that you are receiving the Department's Provider bulletin by signing up to receive emails.

All live UM trainings presented by eQHealth Solutions, Inc are suspended as of January 4, 2021. Providers will still have access to the prerecorded eQHealth trainings on the ColoradoPAR website under Provider resources Providers can request a live training and or 1:1 help session if needed by sending an email to eQHealth\'s Provider relations team at co.pr@eqhs.com.

The Following Information Remains in Effect

• Effective April 1, 2020, the Inpatient Hospital Review Program (IHRP) was suspended due to the Public Health Emergency related to COVID-19 pandemic. Inpatient claims in which the admit date occurs on or after April 1, 2020, will not require an IHRP prior authorization, concurrent or complex case review during the Public Health Emergency (PHE). PARs still need to be entered for Transplants and Out of State inpatient admissions. Providers will be appropriately notified of any changes to the IHRP PAR requirements.

• This is a reminder that the requirement for Prior Authorization Requests (PARs) are currently suspended for Pediatric Long-Term Home Health (PLTHH) and Private Duty Nursing (PDN) as of July 1, 2020. The PAR requirement for PDN and PLTHH will remain suspended through the winter and the earliest these PARs will be resumed is March 1, 2020. The Department will be completing a phased-in implementation and will provide sufficient notice about when PARs will be required and how the requirement will be implemented. Please note: PARs do not need to be submitted to the Department's Utilization Management (UM) vendor, eQHealth Solutions for dates of service beginning July 1, 2020. Any updates will be noticed via Provider Bulletins and the Department's project web page.

COVID-19 RESPONSE - DME RULE 8.590.2.M

To ease provider burden during the COVID-19 pandemic, the Department will not be pending or technically denying DME Rule 8.590.2.M starting June 1st, 2020.

COVID-19 RESPONSE - DME PAR REQUIREMENTS

Effective April 3, 2020, Health First Colorado is waiving prior authorization requirements for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and oxygen-related supplies that are emergently provided for COVID-19 treatment. Please visit Durable Medical Equipment (DME) and Oxygen Supplies for more information.

COVID-19 RESPONSE

If you have a previously approved PAR that needs to be canceled or rescheduled due to COVID-19 and the guidance from CMS and Governor Polis, you may request a date span adjustment of PAR Dates.

Please see How to submit a PAR Date Span Adjustment for more information.