Qualitrac Login Telligen Support Request Form Review Type Comparison
Purpose Telligen Office Hours Training Forms & Templates Memos & Guidance Contacts
Purpose of the HCBS UR/UM Program
The Department currently contracts with a vendor, Telligen, to conduct Utilization Review/Utilization Management (UR/UM) reviews on behalf of the Department. Reviews are conducted to ensure there is no duplication of services and the services requested reflect the identified needs of the waiver participant.
The Department requires the HCBS UR/UM review of:
- Over Cost Containment (OCC) for the following waivers:
- Brain Injury (BI)
- Community Mental Health Supports (CMHS)
- Complementary and Integrative Health (CIH)
- Elderly, Blind, and Disabled (EBD)
- Children’s Extensive Support (CES) waiver eligibility reviews
- Children’s Home and Community-Based Services (CHCBS) waiver eligibility and Cost Containment reviews
- Participant-Directed Programs Health Maintenance Activities (HMA) UR/UM reviews
- Consumer Directed Attendant Support Services (CDASS) for the following waivers:
- BI
- CIH
- CMHS
- EBD
- Supported Living Services (SLS)
- In-Home Support Services (IHSS) for the following waivers:
- CHCBS
- CIH
- EBD
- Consumer Directed Attendant Support Services (CDASS) for the following waivers:
- SLS Exception Reviews (effective 1/2/2022)
- Pre-admission Screening and Resident Review (PASRR)
- PASRR Level I Identification Screening
- PASRR Level II Evaluation
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Telligen Office Hours
The purpose of Office Hours is to provide HCBS Case Managers with UR/UM resources and assistance and will take place once per quarter. Case managers are encouraged to submit suggestions for topics to be covered during the office hours to the Telligen Support Request Form.
These quarterly meetings are intended for case managers only and therefore Telligen communicates directly with case managers with connection information for these meetings.
Upcoming Office Hours
-
August 10, 2023 from 10:30 a.m. to 12:00 p.m.
Meeting Documents
- Telligen Office Hours - Q and A - May 2023
- Telligen Office Hours - Q and A - March 2023
Future Dates
- July
- October
Training Materials
Getting Started with Telligen's Qualitrac Review and Provider Portal
- Provider Portal Registration
- Telligen Qualitrac Portal Registration Training - February 2021
- Webinar Recording - February 2021
- Webinar Transcript - February 2021
- Authorized Official Training User Guide - January 2021
Using Qualitrac
- Using Qualitrac Training Presentation - February 2021
- Webinar Recording - February 2021
- Webinar Transcript - February 2021
- Using Qualitrac Q&A - February 2021
- UR/UM Provider User Guide - Updated July 2022
- Qualitrac Review Request Entry Guide - Updated March 12, 2021
- How to Submit a Review in Qualitrac Using Procedure Codes - May 2022
- Telligen Review Type Comparison - June 2022
Information and Tips for UR/UM Reviews
- Telligen Tip Sheet - September 29, 2021
- Tip Sheet 3 - Tips for SLS Waiver Exceptions and Getting Assistance - January 2022
- Tip Sheet 4 - Tips for Express Reviews - March 2022
- Tip Sheet 5 - Tips for Procedure Codes, Modifiers, and Total Average Daily Cost - Updated April 2022
- Procedure Codes - Modifiers List - Updated September 29, 2022
Forms and Templates
- Express Review Qualification Attestation Form – This form must be submitted with all Express Reviews.
Memos and Guidance
- Informational Memo IM 21-018 - Health Maintenance Activities Documentation - February 23, 2021
- Health Maintenance Activities Documentation Guide - February 2021
- Operational Memo OM 21-017 - LTSS Transition Plan to Telligen for UR/UM Activities - February 3, 2021
- Operational Memo OM 21-014 - Participant Directed Programs UR/UM - January 29, 2021
- Informational Memo IM 21-007 - New Long-Term Care UR/UM Vendor - January 21, 2021
Contacts
- Telligen Call Center - 833-610-1052
- Over Cost Containment Inbox - ltssocc@state.co.us
- Health Maintenance Activity Reviews - PDP_HCPF@state.co.us
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