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CO HCPF Community First Choice (CFC) Billing Manual — Prior Authorization Requests (PARs)

PriorAuthorizationRequests(PARs)

activein force · 2026-07-26 – presentas-observed

AllCFCservicesrequirePriorAuthorizationRequest(PAR)beforetheycanbereimbursedbyHealthFirstColoradounlessotherwisenoted.CMAscompletethePARfortheirspecificprogramsaccordingtoinstructionspublishedintheregulationsfortheDepartmentofHealthCarePolicy&Financing(theDepartment).RefertoAppendixAlocatedontheBillingManualswebpageundertheAppendicesdrop-downfortelephonenumbers.ProviderAgenciesmaycontacttheCMA,ortheProviderServicesCallCenterforthestatusofthePARorinquireelectronicallythroughtheHealthFirstColoradoWebPortal.WhencontactingtheProviderServicesCallcenter,providersmusthavetheMember’sMedicaidIDnumberandthemember’sten-digitPARIDnumber.

TheCMAs’responsibilitiesinclude,butarenotlimitedto:

InformingMembersand/orlegalguardiansoftheeligibilityprocess

DevelopingtheappropriatePAR

SubmittingthePriorAuthorizationinformationtotheauthorizingagent.RefertoAppendixD-Programs/ServicesandAuthorizingAgencieslocatedontheBillingManualswebpageundertheAppendicesdrop-downforalistofauthorizingagents

AssessingtheMember'shealthandsocialneeds

Arrangingforface-to-facecontactwiththeMemberwithin10calendardaysofreceiptofthereferral.

Monitoringandevaluatingservices

ReassessingeachMember

Demonstratingcontinuedcost-effectivenesswheneverservicesincreaseordecrease

PriorauthorizationofservicesdoesnotguaranteeHealthFirstColoradopaymentanddoesnotserveasatimelyfilingwaiver.PriorauthorizationonlyassuresthattheapprovedserviceisamedicalnecessityandisconsideredabenefitoftheHealthFirstColorado.Allclaims,includingthoseforpriorauthorizedservices,mustmeeteligibilityandclaimsubmissionrequirements(e.g.,timelyfiling,Providerinformationcompletedappropriately,requiredattachmentsincluded,etc.)beforepaymentcanbemade.

Priorauthorizationmustbecompletedthoroughlyandaccurately.Ifanerrorisnotedonanapprovedrequest,itshouldbebroughttotheattentionoftheMember'sCaseManagerforcorrections.Procedurecodes,quantities,etc.,maybechangedorenteredbytheMember'sCaseManager.

TheauthorizingagentorCaseManagementAgencyisresponsiblefortimelysubmissionanddistributionofcopiesofapprovalstoagenciesandProviderscontractedtoprovideservices.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 2ad6ca9d839133c9701f3be572ecbbc75bca60ef0d27bacde98dd25fc6605164

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