Audiology Prior Authorization Requests (PARs)

Although most procedures can be processed without prior review and approval, certain procedures require prior authorization. A list of authorizing agencies, addresses, and telephone numbers is located in Appendices C and D in the Appendices of the Provider Services  Billing Manuals section of Department’s Web site. 

Selected surgical procedures and all services provided outside of Colorado, with the exception of emergency services, require prior authorization. Providers must complete, submit, and receive approval of the Prior Authorization Request (PAR) before rendering the service or supply. Surgical procedure codes requiring prior authorization are listed in Appendix M.

Providers are encouraged to submit PARs electronically using the 278 Transaction. Electronically submitted PARs without the minimally required information are rejected. Instructions for completing and submitting electronic PARs are available through the 278 Transaction Companion Guide found on the Department’s Web site in the Provider Services Specifications section.

Electronic PAR submission offers the provider:

1. Immediate system assignment of a PAR number

2. Faster PAR processing

Only Dental Care, Medical Care, and Supply PARs may be submitted electronically through the Web Portal, but all PAR type responses are available for inquiry.

PARs submitted to the fiscal agent by paper must be submitted on the correct PAR form using the national Centers for Medicare and Medicaid Services (CMS) and Current Procedural Terminology (CPT) codes described in this manual. 

PARs submitted to the fiscal agent without utilizing the Healthcare Common Procedural Coding System (HCPCS) codes or on the incorrect form will not be accepted. Paper PAR forms and completion instructions are located in the Provider Services  Forms section.

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 service is 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, Primary Care Physician (PCP) information completed appropriately, third party resources payments pursued, required attachments included, etc.) before payment can be made.

After a PAR has been reviewed, a PAR letter is sent to the provider and the member. For approved services, allow sufficient time for the fiscal agent to enter the PAR data into the Colorado Medical Assistance Program processing system before submitting a claim for the authorized service.

PAR Revisions

Please print “REVISION” in bold letters at the top and enter the PAR number being revised in box # 7. Do not enter the PAR number being revised anywhere else on the PAR.

Paper PAR Instructional Reference

Field Label	Completion Format	Instructions
The upper margin of the PAR form must be left blank. This area is for authorizing agent’s use only.
Invoice/Pat Account Number	Text	Optional Enter up to 12 characters (numbers, letters, hyphens) to identify the claim or member.
1.   Member Name	Text	Required Enter the member's last name, first name and middle initial. Example: Adams, Mary A.
2.    Identification Number	7 characters, a letter prefix followed by six numbers	Required Enter the member's state identification number. This number consists of a letter prefix followed by six numbers. Example: A123456.
3.   Sex	Check box M          F	Required Enter an "X" in the appropriate box.
4.   Date of Birth	6 numbers (MMDDYY)	Required Enter the member's birth date using MMDDYY format. Example: January 1, 2009 = 010109.
5.   Member Address	Characters: numbers and letters	Required Enter the member's full address: Street, city, state, and zip code.
6.   Member Telephone Number	10 numbers ###-###-####	Optional Enter the member's telephone number.

Field Label	Completion Format	Instructions
7.   Prior Authorization Number	None	System assigned Do not write in this area. The authorizing agent reviews the PAR, and approves or denies the services. Enter the assigned PAR number in the appropriate field on the claim form when billing for prior authorized services.
8.   Dates Covered by This Request	6 numbers for from date and 6 numbers for through date (MMDDYY)	Required Enter the date(s) for the requested service(s). If left blank, dates are entered by the authorizing agency. Authorized services must be provided within these dates. If retroactive authorization is requested, enter the date(s) of service and provide justification in field 11 (Diagnosis).
9.   Does Member Reside in a Nursing Home?	Check box Yes           No	Required Enter an "X" in the appropriate box.
10. Group Home Name if Patient Resides in a Group Home	Text	Conditional Enter the name of the Group Home if the member lives in a group home.

Field Label	Completion Format	Instructions
11. Diagnosis	Text	Required Enter the diagnosis and sufficient relevant diagnostic information to justify the request and include the prognosis. Provide relevant clinical information, other drugs or alternative therapies tried in treating the condition, results of tests, etc., to justify a Colorado Medical Assistance Program determination of medical necessity. If diagnosis codes are used, the narrative is also required. Approval of the PAR is based on documented medical necessity. Attach documents as required.
12. Requesting Authorization for Repairs	None	Not required
13. Indicate Length of Necessity	None	Not required
14. Estimated Cost of Equipment	None	Not required
15. Services to be Authorized Line Number	None	Preprinted Do not alter preprinted line numbers. No more than five services or items can be requested on one form.
16. Describe Procedure, Supply, or Drug to be Provided	Text	Required Enter a description of the service(s) that will be provided.
17. Procedure, Supply or Drug Code	Revenue codes - 3 numbers CMS codes - 5 Characters	Required Enter the revenue and/or CMS code(s) for each service that will be billed on the claim form. The code(s) indicated on the PAR form must be used for billing.

Field Label	Completion Format	Instructions
18. Requested Number of Services	3 numbers	Required Enter the number of visits, services, procedures requested. If this field is blank, the authorizing agency will complete it.
19. Authorized No. Of Services	None	Leave Blank The authorizing agency indicates the number of services authorized. This number may or may not equal the number requested in field 18 (Number of Services).
20. Approved Denied	None	Leave Blank No longer used. Refer to the PAR letter or check the PAR online.
21. Primary Care Physician (PCP) Name Telephone Number	Text	Conditional If the member has a primary care physician, enter the name of the primary care physician in this field. Optional Enter the primary care physician’s phone number.
22. Primary Care Physician Address	Text	Optional Enter the address of the primary care physician.
23. PCP Provider Number	8 numbers	Conditional If the member has a primary care physician, enter the primary care physician’s provider number in this field.
24. Name and Address of Physician Requesting Prior Authorization	Text	Required Enter the complete name and address of the provider requesting the PAR. If the clinic is requesting a PAR, enter the audiologist's complete name and address

Field Label	Completion Format	Instructions
25. Name and address of Provider Who Will Render Service Telephone Number	Text 10 numbers ###-###-####	Required If the clinic is requesting a PAR, enter the clinic's name and address. If an independent audiologist is requesting a PAR, enter the audiologist's name and address. Required Enter the telephone number of the rendering provider.
26. Requesting Physician Signature	Text	Required The audiologist requesting the service must sign the PAR. A rubber stamp facsimile signature is not acceptable on the PAR.
27. Date Signed	6 numbers (MM/DD/YY)	Required Enter the date the PAR form is signed by the requesting provider
Telephone Number	10 numbers ###-###-####	Optional Enter the requesting provider's telephone number
28. Requesting Physician Provider Number	8 numbers	Required Enter the eight-digit Colorado Medical Assistance Program provider number of the audiologist requesting the service (the audiologist must be enrolled).
Telephone Number	10 numbers ###-###-####	Optional Enter the telephone number of the rendering provider.

Field Label	Completion Format	Instructions
29. Service Provider Number	8 numbers	Required If the clinic is requesting a PAR, enter the clinic’s eight-digit Colorado Medical Assistance Program provider number. If an independent audiologist is requesting a PAR, enter the audiologist's eight-digit Colorado Medical Assistance Program provider number. The rendering provider must be enrolled with the Colorado Medical Assistance Program.
30. Comments	Text	This field is completed by the authorizing agency. Refer to the PAR response for comments submitted by the authorizing agency.
31. PA Number Being Revised	Text	This field is completed by the authorizing agency

The authorizing agent reviews all completed PARs. The authorizing agency approves or denies, by individual line item, each requested service or supply listed on the PAR. The results of the PAR review are available through the Web Portal and included in PAR letters. Read the response 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.

If the PAR is denied, direct inquiries to the authorizing agency listed in Appendix D of the

Appendices section in Provider Services  Billing Manuals.