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The Department has announced the intent to award the Utilization Management (UM) contract to Keystone Peer Review Organization (KEPRO). Kepro will replace eQHealth Solutions, Inc as the UM Vendor in Spring of 2021. The go-live date for Kepro has not yet been finalized, but additional announcements will be posted to this website and sent out via Provider Bulletin. Please ensure that you are receiving the Department’s Provider bulletin by signing up to receive emails.
All live UM trainings presented by eQHealth Solutions, Inc are suspended as of January 4, 2021. Providers will still have access to the prerecorded eQHealth trainings on the ColoradoPAR website under Provider resources Providers can request a live training and or 1:1 help session if needed by sending an email to eQHealth's Provider relations team at co.pr@eqhs.com.
The following information remains in effect: Effective April 1, 2020, the Inpatient Hospital Review Program (IHRP) was suspended due to the Public Health Emergency related to COVID-19 pandemic.
Inpatient claims in which the admit date occurs on or after April 1, 2020, will not require an IHRP prior authorization, concurrent or complex case review during the Public Health Emergency (PHE). PARs still need to be entered for Transplants and Out of State inpatient admissions. Providers will be appropriately notified of any changes to the IHRP PAR requirements.
The following information remains in effect: This is a reminder that the requirement for Prior Authorization Requests (PARs) are currently suspended for Pediatric Long-Term Home Health (PLTHH) and Private Duty Nursing (PDN) as of July 1, 2020. The PAR requirement for PDN and PLTHH will remain suspended through the winter and the earliest these PARs will be resumed is March 1, 2020. The Department will be completing a phased-in implementation and will provide sufficient notice about when PARs will be required and how the requirement will be implemented.
Please note: PARs do not need to be submitted to the Department's Utilization Management (UM) vendor, eQHealth Solutions for dates of service beginning July 1, 2020. Any updates will be noticed via the Provider Bulletins web page and the Department’s project web page.
To ease provider burden during the COVID-19 pandemic, the Department will not be pending or technically denying DME Rule 8.590.2.M starting June 1st, 2020.
Effective April 3, 2020, Health First Colorado is waiving prior authorization requirements for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and oxygen-related supplies that are emergently provided for COVID-19 treatment. Please visit the Durable Medical Equipment (DME) and Oxygen Supplies web page for more information.
If you have a previously approved PAR that needs to be canceled or rescheduled due to COVID-19 and the guidance from CMS and Governor Polis, you may request a date span adjustment of PAR Dates.
Please see How to submit a PAR Date Span Adjustment for more information.
Items here are updated manually.
Customer Service Line: 888-801-9355 (toll free)
Provider Fax Line: 866-940-4288 (toll free)
Mailing Address: eQHealth Solutions (Attn: Colorado Medicaid Program) 5802 Benjamin Center Dr., Suite 105, Tampa, Florida 33634
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