Colorado Prior Authorization Requests Program (CO-PAR)
ColoradoPAR Program Background
The ColoradoPAR Program is Colorado Medicaid's utilization management (UM) program. A third party vendor reviews Prior Authorization Requests (PARs) to ensure items and services requested meet medical necessity guidelines and are within Colorado Medicaid’s policies.
What are the Goals of the ColoradoPAR Program?
- Improve health outcomes of Medicaid clients;
- Decrease costs by eliminating duplicative and unnecessary services; and
- Allow providers to easily track the status of their prior authorization requests (PARs) using a web portal, rather than a paper process.
Key activities performed by the ColoradoPAR Program
- Prior Authorization Requests (PARs): Providers request authorization for services before providing certain services. The ColoradoPAR vendor reviews the request to determine if services are medically necessary according to established criteria and guidelines. The ColoradoPAR Program reviews PARs for the following categories of services and supplies:
- Diagnostic imaging
- Durable medical equipment (DME)
- Inpatient out-of-state admissions
- Medical services, including transplant and bariatric surgery
- Physical & occupational therapy
- Pediatric long term home health (LTHH)
- Private duty nursing
**Please note: For the above categories, all PARs for clients age 20 and under are reviewed according to EPSDT guidelines.
- Retrospective Reviews: The ColoradoPAR vendor reviews documentation of care that has already been provided to ensure care was appropriate and claims were accurately submitted and paid.
- Medical Management Consultation: The ColoradoPAR vendor assists with planning, coordination, and evaluation of care to cost-effectively improve health outcomes.
Who Performs UM activities for Colorado Medicaid?
- APS Healthcare administers the ColoradoPAR Program as Colorado Medicaid’s UM vendor, until September 1, 2015.
- After September 1, 2015, eQHealth Solutions has been selected to perform UM activities.
ColoradoPAR Program Vendor Transition
eQHealth Solutions was selected by the Department to provide utilization management services beginning September 1, 2015. eQHealth Solutions will review and authorize prior authorization requests (PARs) for the ColoradoPAR Program.
eQHealth Solutions will help modernize the ColoradoPAR Program to improve provider satisfaction and client access to appropriate care. Plans to improve the ColoradoPAR Program include:
- State of the art online provider PAR portal.
- Real-time determinations for the majority of PARs.
- Improved turnaround times, including PAR revision requests.
- Initiating contact with ordering physicians for a Peer-to-Peer (physician-to-physician) review prior to issuing a PAR denial.
- Dedicated staff for provider relations and outreach.
- Provider email communication containing important information, including specific information for provider specialties (i.e. LTHH, DME, Audiology).
Future ColoradoPAR Provider Portal: eQSuite®
eQSuite® is eQHealth Solutions’ proprietary, web-based, HIPAA-compliant prior authorization request system, which offers providers 24/7 accessibility to the information and functions providers need.
eQHealth Solutions will offer general and customized webinar trainings beginning Monday, August 17th. Providers may register for eQSuite® trainings at http://co.eqhs.org beginning the first week of August.
- Webinars will be held multiple times per weekday, as well as evenings and some Saturdays, to accommodate providers’ busy schedules.
- Webinars for each PAR type will be recorded and available for review at a later date.
- There are no attendance limitations. Providers are encouraged to attend more than one training if they feel additional sessions are needed.
- Attendees will receive an email following each webinar that can be used for questions. Questions will be answered and posted to a FAQ sheet available to all providers.
Providers must complete and submit the Request for eQSuite® Access form. A logon must be assigned and a system administrator designated for each individual provider Medicaid number. The system administrator assigns and maintains logons for all eQSuite® users assigned to enter PARs under that Medicaid number. This form can be accessed at http://co.eqhs.org, under Provider Resources, Forms and Instructions.
ColoradoPAR Provider Helpline :
- (for current PAR’s until 9/1/15): 1-888-454-7686
- (for eQSuite training, questions on PAR portal sign-up, questions on PARs submitted after 9/1/15): 1-888-801-9355
Medicaid Client Customer Service: