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ColoradoPAR Program

The ColoradoPAR Program is the Utilization Management program for the Colorado Medical Assistance Program. 

 

ColoradoPAR process the following PAR types

·         Dental

·         Diagnostic imaging – limited to non-emergency Computed Tomography (CT) Scans and Magnetic Resonance Imaging (MRI), and all Positron Emission Tomography (PET) Scans

·         Durable Medical Equipment (DME)/Supply – All (including repairs)

·         Home Health – Pediatric Home Health (formerly known as EPSDT Extraordinary and Long Term Home Health for Children)

·         Medical/Surgical services

·         EBI Bone Stimulator

·         Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

·         Second surgical opinions

·         Physical and occupational therapy (OT/PT) services

·         Out-of-state Transportation

·         Out-of-state non-emergency surgical services

·         Organ transplantation

·         Orthodontia

·         Private Duty Nursing (PDN)

·         Vision

For questions and additional assistance, please contact the ColoradoPAR Program information line at 1-888-454-7686 or visit the ColoradoPAR Program website.

 

PAR Submission

All PARs and revisions processed by and submitted to the ColoradoPAR Program must be entered through the ColoradoPAR Program web portal, CareWebQI (CWQI).

 

CareWebQI Portal Training

Medical Tutorial

Dental/Orthodontics Portal Training

Dental/Orthodontics Tutorial

Home Health Pediatric Assessment Tool (PAT) Training

 

Paper PARs

Do not submit PARs on paper unless an exception is granted by the ColoradoPAR Program. Exceptions may be granted for providers who submit five (5) or less PARs per month. PAR forms are located in the Provider Services Forms section of the Department’s website.

 

Submit Supporting Clinical Documentation through CWQI

After answering the clinical questions in CWQI, submit all relevant clinical information needed so PAR determination can be made in a timely manner. Documents may include clients’ histories and physical reviews, progress and office notes, lab results, and current medications. If any information is missing or inadequate, a message will be sent to the submitter via the CWQI message system.

Missing or inadequate clinical information will result in lack of information (LOI) denials. PAR submitters have 24 hours to respond to requests for more information before LOI denials are issued.

Submit all clinical documentation, including digital X-rays, in the following formats: doc; docx; xls; xlsx; ppt; pdf; jpg; gif; bmp; tiff; tif; and jpeg.

If clinical documentation cannot be submitted electronically, fax or mail to:

Fax: 1-866-492-3176

Mail: ColoradoPAR Program
55 N. Robinson Avenue, Suite 600
Oklahoma City, OK 73102

 

Reconsideration Requests

Reconsideration requests can be made through either of the processes noted below:

The Peer-to-Peer Process to discuss denial determination occurs when a:

·         Request made by the provider within five (5) calendar days since a denial decision for a verbal discussion with a ColoradoPAR physician to discuss denial determination.

·         Review of additional clinical information is submitted within the first 5 calendar days since a denial decision.

The Reconsideration Process is a second review by a non-ColoradoPAR physician that and must be requested by the provider within ten (10) calendar days of the denial decision, and goes through the following process:

·         Review is completed by a physician of the same profession and specialty as the ordering physician.

·         Review will include all information submitted and any additional information the provider wishes to submit.

·         Physician may overturn or uphold the original denial decision.

Note: The Peer-to-Peer Process does not need to be utilized prior to the Reconsideration Process.

 

Appendix D

Appendix D - Program/Services and Authorizing Agencies contains the current authorizing agency for specific PAR types. Appendix D is located in the Appendices of the Provider Services Billing Manuals section.

 


Provider Bulletins containing ColoradoPAR Program information:
 
Medicaid Program News and Updates
 

24 Hour Nurse Hotline, 1-800-283-3221

Did you know that Medicaid offers this free service to all of its Primary Care Physician Program and fee-for-service clients? Whenever a client is hurt or sick, please encourage him or her to call the nurse hotline prior to seeking treatment. This can help reduce unnecessary emergency room and office visits and allow providers more time to spend with those who truly need medical attention. By promoting this nurse hotline to your Medicaid patients, it enables an RN to assess the client's condition and direct his or her care appropriately. This service is available after hours too! For more information, or to request promotional materials, please contact the Department at 1-800-221-3943.

 

ColoradoPAR Program Website and Contact Information

ColoradoPAR Program

Phone:

1-888-454-7686

Mail:

55 N. Robinson Avenue, Suite 600

Fax:

1-866-492-3176

 

Oklahoma City, OK 73102