Reproductive healthcare services, including prenatal and postpartum care, do not require a referral from the member's PCP if the member receives those services from a CHP+ contracted provider.
A Primary Care Provider (PCP) does not need a referral for routine services provided within the PCP practice group. One PCP practice can refer to another PCP practice in an urgent care situation, for a second opinion, or in an on-call situation.
|Services not requiring prior authorization:
- Emergency department visits
- Urgent Care visits
- Reproductive Health Services (provided by a CHP+ participating provider)
- Emergent Ambulance Transfers
- Routine Vision Exams - 1 visit/year
- Specialist visits (by a Participating Provider)
- Routine Behavioral Health care
Colorado Access has Removed the Authorization Requirement for Outpatient Behavioral Health Service. Enhancement Effective March 17, 2009 for ALL Lines of Business. See details.
|Services requiring a referral or authorization:
- Inpatient Facility stays
- Certain Durable Medical Equipment
- Hearing Aids
- Developmental Evaluations
- Certain surgical procedures
- Physical Therapy, Speech Therapy, Occupational Therapy
- Non-Emergent Ambulance services
- Certain medications
Please refer to our General Authorizations document available for download here.
Retroactive authorizations will not be assigned unless approved by CHP+.
How to determine what services require a pre-authorization:
A comprehensive list of procedure codes and corresponding authorization requirements is located on the Colorado Access website at www.coaccess.com. To access the list, click on For Our Providers. Then, click on Provider Logon and enter your Colorado Access Username and Password. From the Provider Welcome page, click on Authorization List to access the list in PDF format.
If you do not have a Colorado Access Username and Password, please complete the Web Based
Applications Request Form located on the Colorado Access website at
https://providers.coaccess.com/providers/files/WebAccessApplication.pdf. Fax or email the
completed form to (303) 755-2368 or PNS@coaccess.com.
How to request a pre-authorization:
All CHP+ referral and authorizations can be requested either by telephone or by fax.
The following information is needed when calling Colorado Access for referrals and authorizations:
- Name of PCP practice
- Diagnosis by ICD-9 code
- Patient's name
- Patient's Member ID number
- Patient's date of birth
- Specific services being requested
- Number of visits being requested
- Specialist being referred to