General Prior Authorization Requirements

Long-Term Home Health (LTHH) PARs 

All LTHH Services shall be submitted to the Department’s authorizing agency as soon as possible, but no more than 10 business days from the start date of the LTHH PAR. Authorizing agency information is listed in Appendices C and D of the Appendices located in the Provider Services Billing Manuals section of the Department’s website. The Home Health PAR form must be completed and reviewed by the Department’s authorizing agency before services can be billed.

Long-Term Home Health PARs that are not received by the authorizing agency in a timely manner shall have the PAR start date amended to 10 business days prior to the date the PAR was originally scheduled to start.

A PAR is not considered complete until the authorizing agency reviews all information necessary to review the request. All LTHH PAR submissions must include: 

o Client’s diagnoses that will be addressed by Home Health, using V-codes whenever appropriate; 

o The specific frequency and expected duration of the visits for each discipline ordered; and 

o The duties/treatments/tasks to be performed by each discipline during each visit. 

 All other supporting documentation to support your request including physician’s orders, treatment plans, nursing summaries, nurse aide assignment sheets, medications listing, etc; and

  Any other documentation deemed necessary by the Department or its authorizing agency. 

The plan of care must be created by a registered nurse employed with the Home Health Agency or when appropriate by a physical, occupational or speech therapist. The plan of care must be signed by the client’s attending physician prior to submitting the final claim for a certification period.

Adult PARs 

All adult LTHH PARs must be submitted on the Department’s designated Long Term Home Health PAR form.

The authorizing agency reviews all completed PARs and approves or denies, by individual line item, each requested service listed on the PAR. PAR status inquiries can be made through the File and Report System (FRS) in the Web Portal and PAR determinations are included on PAR letters sent to both the provider and the client. Read the determination carefully as some line items may be approved and others denied. Do not render or bill for services until the PAR has been processed. The claim must contain the PAR number for payment. 

Approval of a PAR does not guarantee Colorado Medical Assistance Program payment and does not serve as a timely filing waiver. Prior authorization only assures that the services requested are considered a benefit of the Colorado Medical Assistance Program. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g. timely filing, third party resources payment pursued, required attachments included, etc.) before payment can be made. 

If the PAR is denied, providers should direct inquiries to the authorizing agency who reviewed the PAR.

PAR Revisions 

If the number of approved units needs to be amended, the provider must submit a request for a PAR revision prior to the PAR end date. Changes requested after a PAR is expired will not be made by the Department or the authorizing agency.

Note: When a PAR is revised, the number on the original PAR must be used on the claim. (Do not use the PAR number assigned to the revision when completing a claim. Use the original PAR number.) 

Pediatric Long-Term Home Health PAR revisions should be completed in eQSuite®. Adult LTHH PAR revisions must be made on the Department’s designated form and submitted to the authorizing agency for review. Complete the Revision section of the PAR and include the PAR number that you need to be revised.

Note: The number of units should equal more/less the number of units planned for use during the PAR period. The number of units being requested needs to be added to the original number of units approved and include all services that were approved on the original PAR.