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CO HCPF Children's Habilitation Residential Program (CHRP) Waiver Program Billing Manual — Prior Authorization Requests (PARs)

PriorAuthorizationRequests(PARs)

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

AllHCBSservicesrequirepriorauthorizationbeforetheycanbereimbursedbyHealthFirstColorado.CaseManagersatone(1)ofthe20CMAscompletethePriorAuthorizationRequestsfortheirspecificprogramsaccordingtoinstructionspublishedintheregulationsfortheDepartmentofHealthCarePolicy&Financing(theDepartment).

TheCMA'sresponsibilitiesinclude,butarenotlimitedto:

InformingMembersand/orlegalguardianoftheeligibilityprocess

SubmittingevidenceofMembereligibilityforthewaivertothecountyDepartmentofHuman/SocialServicesforaHealthFirstColoradoMemberidentificationnumber

DevelopingtheappropriatePriorAuthorizationRequestofservicesandprojectedcostsforapproval

Astheauthorizingagent,submittingthepriorauthorizationinformationtothefiscalagent.RefertoAppendixDlocatedontheBillingManualswebpageundertheAppendicesdrop-downforalistofauthorizingagents.

AssessingtheMember'shealthandsocialneeds.

Arrangingforface-to-facecontactwiththeMemberwithin30calendardaysofreceiptofthereferral

Monitoringandevaluatingservices

ReassessingeachMember

Demonstratingcontinuedcost-effectivenesswheneverservicesincreaseordecrease

Approvalofpriorauthorizationdoesnotguaranteepaymentanddoesnotserveasatimelyfilingwaiver.PriorauthorizationonlyassuresthattheapprovedserviceisamedicalnecessityandisconsideredabenefitofHealthFirstColorado.Allclaims,includingthoseforpriorauthorizedservices,mustmeeteligibilityandclaimsubmissionrequirements(e.g.,timelyfiling,ProviderAgencyinformationcompletedappropriately,requiredattachmentsincluded,etc.)beforepaymentcanbemade.

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

TheauthorizingCMAisresponsiblefortimelysubmissionanddistributionofcopiesofapprovalstoProviderAgencies.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: 85f8cac259c8fe178d630ea12868869d2dbd66b2ffd31b067754cf985fe40c74

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