PAR Frequently Asked Questions (FAQs)

What is the difference between CFMC and ACS?

Colorado Foundation for Medical Care (CFMC) is the Quality Improvement Organization for the state of Colorado, and has a contract with CDHCPF to review Prior Authorization Requests (PARs) for medical necessity. CFMC provides this review for the following:

• Certain surgical procedures, including transplants
• Certain durable medical equipment, including power wheelchairs and scooters, augmentative communication devices, respiratory devices, and certain prosthetic and orthotic equipment
• Physical and occupational therapy
• Substance use disorder and mental health treatment
• Certain non-emergency transportation services
• EPSDT home health services
• Out-of-state elective hospital admissions

Affiliated Computer Services (ACS) is the fiscal agent for Colorado Medicaid. ACS performs the following, among other services:

• Review of PARs for other types of services (such as manual wheelchairs and repairs for equipment)
• Data entry of PARs into the database
• Sending notification of approval or denial of services to clients and providers
• Claims processing

How soon after I submit a PAR to CFMC will I be notified of the outcome?

By contract, CFMC has ten business days after the receipt of all information to review a PAR and submit it to the fiscal agent (ACS). Once the PAR is received at ACS, they then have an additional ten business days to complete the process.

Where should I send a PAR that needs to be reviewed by CFMC?

You may fax the PAR form and additional information (including the physician’s prescription, progress notes, and any required questionnaire to support medical necessity of the request) to: 303.695.3377.

You may also mail the information to:

Colorado Foundation for Medical Care
23 Inverness Way East, Suite 100
Englewood, CO 80112-5708

• CFMC Medicaid Review Services 24 hour toll free number 1-800-333-2362 or locally at   303-695-3300 x3129.

Our staff is available during regular business hours from 8 a.m. to 4:30 p.m. MST Monday through Friday (excluding holidays). A message can be left after business hours and a CFMC representative will call you back no later than the next business day.

How do I know if something needs to be prior authorized? How do I know what needs to be sent to CFMC and what needs to be sent to ACS?

Please refer to the Colorado Medicaid Manuals and the Colorado Medicaid Reference Bulletins available at the ACS web link for the most current information. (Links open new windows.)

Colorado Medicaid Reference Bulletins:
http://www.chcpf.state.co.us/ACS/Provider_Services/Bulletins/Bulletins.asp

Web link to ACS:
http://www.chcpf.state.co.us/ACS/Provider_Services/provider_services.asp