CO · guidance

CO HCPF Home and Community Based Services (HCBS) Complementary and Integrative Health (CIH) Manual — Prior Authorization Requests (PARs)

PriorAuthorizationRequests(PARs)

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

Unlessotherwisenoted,allHCBSservicesrequirepriorapprovalbeforetheycanbereimbursedbyHealthFirstColorado.CaseManagementAgenciescompletethePriorApprovaland/orCostContainmentrequestsfortheirspecificprogramsaccordingtoinstructionspublishedintheregulationsfortheDepartmentofHealthCarePolicyandFinancing(theDepartment).

RefertoAppendixAlocatedontheBillingManualswebpageundertheAppendicesdrop-downfortelephonenumbers.

FortheHomeandCommunityBasedServicesComplementaryandIntegrativeHealth(HCBS-CIH)waiver,thefollowingservicesmustbesubmittedbytheCaseManagementAgency(CMA)totheDepartmentforapproval:

Allservicesabovecostcontainment

ProviderAgenciesmaycontacttheCMAforthestatusofthePARorinquireelectronicallythroughtheHealthFirstColoradoOnlineProviderWebPortal.

TheCMAs'responsibilitiesinclude,butarenotlimitedto:

InformingMembersand/orlegalguardianoftheeligibilityprocess.

TransmittingacopyoftheapprovedEnrollmentFormtotheCountyDepartmentofHuman/SocialServicesforaHealthFirstColoradoMemberidentificationnumber.

DevelopingtheappropriatePriorAuthorizationFormofservicesandprojectedcostsforapproval.

Submitting-thePriorAuthorizationtotheHCPFauthorizingagent.RefertoAppendixDlocatedontheBillingManualswebpageundertheAppendicesdrop-downforalistofauthorizingagents.

AssessingtheMember'shealthandsocialneeds.

Arrangingforface-to-facecontactwiththeMemberwithin10calendardaysofreceiptofthereferral.

Monitoringandevaluatingservices.

ReassessingeachMembernolessfrequentlythanannually.

Demonstratingcontinuedcosteffectivenesswheneverservicesincreaseordecrease.

ApprovalofapriorauthorizationdoesnotguaranteeHealthFirstColoradopaymentanddoesnotserveasatimelyfilingwaiver.PriorauthorizationonlyassuresthattheapprovedserviceisamedicalnecessityandisconsideredabenefitofHealthFirstColorado.Allclaims,includingthoseforpriorauthorizedservices,mustmeeteligibilityandclaimsubmissionrequirements(e.g.,timelyfiling,providerinformationcompletedappropriately,requiredattachmentsincluded,etc.)beforepaymentcanbemade.

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

TheauthorizingagentorCaseManagementAgencyisresponsiblefortimelysubmissionanddistributionofcopiesofapprovalstoProviderAgenciescontractedtoprovideservices.

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TheHCBS-CIHformsareelectronicallyfiledviathe"Bridge"whichdirectlyinterfaceswiththeColoradointerChangeSystem.AccesstotheBridgeisaccomplishedviatheMedicaidEnterpriseUserProvisioningSystem(MEUPS).OnlyCaseManagersmayaccesstheBridge.ProviderAgenciesarenotaffordedaccesstotheBridge,butmayobtainPARinformationfromCaseManagers,theProviderServicesCallCenter,orthroughtheProviderWebPortal.

Thisisanelectronicprocess.Paperdocumentscannotbesubmitted.

Note:IfsubmittedtotheDepartment'sfiscalagent,thefollowingcorrespondencewillnotbereturnedtoCaseManagers,outreachwillnotbeperformedtofulfilltherequests,andallsuchrequestswillberecycled:1)PaperPARforms2)PARrevisionrequests.Shouldquestionsariseaboutwhatfiscalagentstaffcanprocess,contacttheappropriateDepartmentbenefitsmanager.

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Provenance

Source: hcpf.colorado.gov
Retrieved: 2026-07-26
Edition: 2026-07-26
Content hash: fe5eae265d81e6bd842fb267952d9f4adbb869a9dfffd8f3f664c1ec0c5c4349

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