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:
- Behavioral Therapy
- 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.
***ColoradoPAR does not review services for Behavioral Health Services, Dental/Orthodontia, Pharmacy, and Transportation. Please visit the Department’s website for information for additional information on these services at https://www.colorado.gov/hcpf/provider-help.
Additional UM activities:
- 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?
eQHealth Solutions was selected by the Department to provide utilization management services beginning September 1, 2015. eQHealth Solutions reviews and authorizes prior authorization requests (PARs) for the ColoradoPAR Program.
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.
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 the ColoradoPAR website, under Provider Resources, Forms and Instructions.
For additional information on ColoradoPAR, please see the ColoradoPAR website.
ColoradoPAR Provider Helpline: 1-888-801-9355
Medicaid Client Customer Service: 1-800-221-3943