FOR INITIAL REQUESTS ONLY (applicable for immediate discharge needs)
- Denver Health Medical Plan (DHMP) Utilization Management (UM) will review Prior Authorization Request submissions for APPROVAL up to three business days after the start of care.
- This policy for immediate post-discharge services applies to the following:
- Home health visits
- DME needed within 24 hours of discharge
- Supplies needed within 24 hours of discharge
FOR REQUESTS OF ALL TYPES
The provider must submit the request within three business days of the start of the service and have all the required elements, including a verbal provider order and appropriate clinical documentation. While preferred, written provider orders are no longer required at the time of prior authorization submission.
Prior Authorization Request submissions must be accurately filled out and legible. If the DHMP UM Department cannot read your Prior Authorization Request, it will be returned unprocessed and potentially cause delays to needed services.
Please ensure that dates of service needed on the Prior Authorization Request submission are closely aligned to actual dates of care.
The DHMP UM Department cannot modify approved units or dates of service once a decision has been rendered. Dates of service can ONLY be extended with a new request submission.
Each submission must be on a new Prior Authorization form, with a new cover sheet. This will eliminate confusion and allow for efficient review of processing requests for approvals. Please do not submit duplicate requests.
Home care requests will be re-evaluated every 60 days minimally, to allow for any medically necessary adjustments to treatment plans. Authorizations for home care services greater than 60 days will not be accepted. Please note that DHMP pays for the initial 60 days of home health care for Medicaid Choice members. Health First Colorado (State of Colorado Medicaid program) pays for home health services after the initial 60 days.
Prior Authorization Requests for services which have already been submitted for claims payment will be returned without processing. For example, if the claim is denied, the DHMP Claims Department will provide information on the claims appeals process. We are unable to generate an authorization for service retrospectively after the claim has been filed or modify a request once a decision has been rendered.
Thank you for being a valued partner in serving our Denver Health Medical Plan members