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Frequently Asked Questions
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.
Additionally, the Department will be adding a select group of Physician Administered Drugs (PADs) to require prior authorization that will be implemented with KEPRO. Information pertaining to PAD prior authorization requests will be posted on this page within the coming weeks. Proposed PADs to be prior authorized will be reviewed at the February Drug Utilization Review (DUR) Board meeting; DUR specific information can be found on the DUR web page.
COMING SOON: Appendix Y - Physician Administered Drug Medical Benefit Prior Authorization Procedures and Criteria
PAD Billing Manual
Appendix X: HCPCS-NDC Crosswalk
PAD Fee Schedule
Pharmacist Enrollment: Over-the-Counter and Immunizations
If you need any further information, please contact Felecia Gephart at Felecia.Gephart@state.co.us.
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