Provider Tips for Early Intervention Services (EIS)

Medicaid Members require prior authorization for all EIS care

Prior authorization submissions must be completely and accurately filled out.
Requests must be legible and free from any scratch outs or use of white out.
Each submission must be on a new prior authorization form with a new cover sheet.
Request must contain an IFSP form which is less than 12 calendar months old.
Domains must be completed and show at least a 33% delay in 1 of the 5 domains if it is not a State approved auto qualifying diagnosis.
Approvals will be granted for either 90 days or maximum of 6 months for any PT/OT/ST request for Medicaid Members.
1 year requests for authorizations will not be allowed.
If there is a change in servicing providers, DHMP must be notified immediately. A new prior authorization request must be submitted along with the Colorado Fee-for-Service Medicaid Change of Provider Form.

30-day retroactive reviews are allowed for initial evaluations ONLY for PT/ST/OT.
Current IFSP is required for initial start of services.
A denial will be issued if clinical is not received after day 7 of submission.

Any modification (extended dates or additional visits) requires a new submission.
A current IFSP is required for continued or extension of services.
Summary document or current clinical with progression/regression and functional status from Therapist are needed for each new request.
A denial will be issued if clinical is not received after day 7 of submission.

With the exception of initial service requests, all services submitted after the start of care will be considered retrospective requests and will be processed as denials.
UM is unable to process a Prior Authorization Request for services which have already been submitted for claims payment. Please see the Claims decision letter for denials.