ColoradoPAR: Health First Colorado Prior Authorization Request Program

Attention All Providers

 

Provider Updates

Private Duty Nursing (PDN) Adult Prior Authorization Reviews (PARs)

Providers will be able to submit PARs exceeding the 16 hours per day limit for members aged 21 and older beginning August 12, 2022 contingent upon MSB approval of the emergency PDN PAR Rule.  

  • Providers may request a maximum of 23 hours per day for adult members.
  • PARs will be reviewed for medical necessity on a case-by-case basis.
  • The PDN Tool, the Plan of Care (POC), the Physician order and all supporting documentation remains required for all PDN PARs. 
  • New PAR: For adult members who do not have an active PAR in place, a new PAR should be submitted. Please note, as of 9/1/2022, PARs are required for all PDN services.
  • For members who currently have an active PDN PAR: 
    • Requests for increase of hours on PARs already in place should be submitted as a PAR Revision, also called a PAR Modification, to the current PAR.
      • The start date should be updated to 08/12/22 but no changes should be made to the PAR’s original end date. 
      • Requests to back date the PAR prior to 08/12/22 will be denied. 
      • Please do not submit a new PAR, as this would overlap with the existing PAR and therefore increase the likelihood the claim will deny for duplication of services. 
    • The Physician order, POC, the PDN tool and any additional documentation must appropriately reflect the hours requested. If the documentation from the original PAR does not reflect the hours requested in the PAR Revision request, please ensure you submit the updated documents. Failure to upload these documents may result in the PAR being pended for additional information. 
    • Because this is a PAR Revision, an updated physician order is not required if the date span on the PAR Revision include a start date of 8/12 through the original PAR end date. 

 
For more information on how to properly submit these cases as a PAR Revision, please contact Kepro at coproviderissue@kepro.com.  

For questions about the PAR process or to escalate questions, please contact the UM Team at hcpf_um@state.co.us

For questions about the PDN Rule and/or PDN Benefit or Policy, please contact the Office of Community Living PDN Benefit Management Team at HCPF_HCBS_Questions@state.co.us.

Attention Physical, Occupational and Speech Therapy Providers

The Department of Health Care Policy and Financing (HCPF) and the Department's Utilization Management (UM) Vendor, Kepro, will be holding training specific to Health First Colorado Therapy Providers that submit Prior Authorization Requests (PARs) to Kepro.

Benefit Specific Training: On August 10, 2022, Kepro will provide three separate training sessions (8:30am, 12pm, 3pm MT) to assist you in submitting successful PARs. This training will cover the following topics:

  • ST Change in Policy to allow for up to 365-day PARs 
  • Required documents and documentation
  • Revisions
  • Reconsiderations
  • Peer-to-Peer

You can register for a training session using the Kepro Provider Training Registration Links; you will need to register prior to attending a training webinar.

For any questions, please contact COproviderissue@kepro.com.

If you have any questions related to PARs for the Department please contact hcpf_um@state.co.us.

Longer Pend Times for Kepro PARs  

We heard from you Colorado Providers and we are making changes. Effective April 4th, 2022, all providers will have 10 business days to respond to Kepro's pends asking for additional information to complete medical reviews for PARs. Providers will notice the timeline change in Atrezzo, Kepro's portal, and in response notes from utilization management reviewers.  PARs pending for additional information dated prior to April 4th, 2022, will have 7 business days to respond.  Please reach out to the utilization management inbox at hcpf_um@state.co.us with questions or concerns. 

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.

Atrezzo Update: Beginning February 1, 2022, you will see a slightly different look to your home page in Kepro’s Atrezzo Provider Portal.  This change is mostly cosmetic and will not change how you create or work within cases. The main change is the case search bar will be moving from the left side of the screen to the right side.  Please feel free to contact Kepro at coproviderissue@kepro.com or 720-689-6340 if you have questions about this change.

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

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

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.

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.

 

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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.

 

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