HCBS Utilization Review/Utilization Management
Qualitrac Login Telligen Support Request Form Review Type Comparison HMA Documentation Guide
Purpose Telligen Office Hours Training Forms and Templates Memos and Guidance Contacts
Purpose of the HCBS UR/UM Program
The Department of Health Care Policy and Financing (HCPF) currently contracts with a vendor, Telligen, to conduct Utilization Review/Utilization Management (UR/UM) reviews. Reviews are conducted to ensure there is no duplication of services and the services requested reflect the identified needs of the waiver participant.
Note: Over Cost Containment (OCC) Reviews no longer apply to PARs effective July 1, 2025.
HCPF requires the HCBS UR/UM review of:
- Children’s Extensive Support (CES) waiver eligibility reviews
- Participant-Directed Programs Health Maintenance Activities (HMA) UR/UM reviews
- Consumer Directed Attendant Support Services (CDASS) for the following waivers:
- Brain Injury (BI) waiver
- Complementary and Integrative Health (CIH) waiver
- Community Mental Health Supports (CMHS) waiver
- Elderly, Blind and Disabled (EBD) waiver
- Supported Living Services (SLS) waiver
- In-Home Support Services (IHSS) for the following waivers:
- Children's Home and Community Based Services (CHCBS) waiver
- CIH waiver
- EBD waiver
- Consumer Directed Attendant Support Services (CDASS) for the following waivers:
- SLS Exception Reviews (effective 1/2/2022)
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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.
Meeting Documents
- Telligen Office Hours Q and A - February 2025
- Telligen Office Hours Q and A - November 2024
- Telligen Office Hours Q and A - August 2024
- Telligen Office Hours Q and A - May 2024
- Presentation
- Documentation Examples - May 2024
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
- Qualitrac Multi-Factor Authentication Tip Sheet - July 2025
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 Program Manual - Updated July 2025
- UR/UM Case Management Agency Training - December 2023
- Telligen Review Type Comparison - June 2022
- Qualitrac Review Request Entry Guide - Updated March 12, 2021
Information and Tips for UR/UM Reviews
- UR/UM Checklist for Case Managers - March 2025
- 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 - November 2024
- Tip Sheet 5 - Tips for Procedure Codes and Total Average Daily Cost - November 2024
Forms and Templates
- Express Review Qualification Attestation Form – This form must be submitted with all Express Reviews.
Memos and Guidance
- Operational Memo OM 25-020 - Closeout Plan for UR/UM Activities for HCBS - March 2025
- Informational Memo IM 21-018 - Health Maintenance Activities Documentation - February 23, 2021
- CFC Health Maintenance Activities Documentation Guide - Updated July 2025
- 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
- Health Maintenance Activity Reviews - PDP_HCPF@state.co.us
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