Provider Tips for Authorization Submissions

Authorization Submission

Please submit a separate authorization request form if both retrospective and prospective services are being requested for a member. Submitting one form for retrospective services and one form for prospective services helps our staff to triage requests and expedite reviews.

Exceptions:

Durable Medical Equipment (DME) and Children’s Burn Center requests received within five (5) business days after the start of care
Early Intervention Services within 30 days of initial start of care

Authorization Requests

For Home Health Care
Tier 1 Home Health Providers Only
- No authorization required day 1 - 30
- If continued care is needed, authorization requests must be submitted prior to care being received on day 31
Tier 2 and Tier 3 Home Health Providers (Out of Network)
- Must submit authorization prior to the start of care
For Durable Medical Equipment (DME) and Children’s Burn Center requests, Denver Health Medical Plan (DHMP) Utilization Management will allow submissions no later than five (5) business days after the start of care.
Denver Health Medical Plan (DHMP) Utilization Management will allow submissions for Early Intervention Services within 30 days of initial start of care
For all other services, a prior authorization form must be received prior to the start of services.
Prior authorization request submissions must be completely and accurately filled out.
Requests must be legible and free from any scratch outs or use of white out.
If a DHMP member is admitted to your facility, you must notify DHMP within 24 hours. If you fail to notify DHMP during this window of time, the member’s admission and continued stay could be denied for “not timely notification."

Extension of Services

DHMP will not modify a request once a decision has been rendered.
For any modification (extended dates or additional visits) to the original authorization request requires a new submission.
Each submission must be on a new prior authorization form with a new cover sheet.
Do not submit duplicate requests, as this will delay processing.
Each prior authorization request submission will generate a new authorization number.
Home care requests:
- DHMP requires a re-evaluation every 60 days.
- Elevate Medicaid Choice Members (wraparound benefit): DHMP covers acute care for the first 60 days. Long term care or care beyond 60 days is processed by the State. Please submit to the HCPF Provider Portal.
- Home Health orders must be signed by the provider prior to claims submission.

Retrospective Requests (Post Service)

Services submitted after the start of care will be considered retrospective requests.
If claims have already been submitted, please follow the instructions given by the Claims Department for denials received for not obtaining a prior authorization by DHMP prior to services being rendered.