KPCO Commercial & Medicare LOB Guidelines Pre-Auth & Inpatient Reminders_2021*
KPCO Medicare Authorization Requirements - 2021*
KPCO Commercial LOB Authorization Requirements_2021*
KPCO Authorization Requirements Apria National Ordering Guide*
KPCO Commercial & Medicare LOB Auth Req – J Codes_2021*
KPCO Commercial & Medicare LOB Auth Req – DME Exceptions_2021*
KPCO Prior Authorization Form*
KPCO Authorization Form (editable version)*
Learn about our authorizations policies, including process and procedures, denials, and appeals.
Acute Rehab /LTACH reviews- Kaiser Permanente Colorado conducts medical necessity reviews for Acute Inpatient Rehabilitation and Long-Term Acute Care Hospitalizations utilizing MCG guidelines. When cases are approved the authorization will be valid for 48 hrs. If the member does not admit within 48 hrs., the request for desired level of care will need to be re-submitted with updated clinicals for review. Once the member has admitted to the chosen AR/LTACH the initial authorization period for Commercial Members will be for 7 days. The initial authorization period for Medicare Members will be 14 days for AR and 25 days for LTACH. Concurrent/Continuation of Care reviews will be conducted biweekly, with authorizations updated by 4:00pm to facilities via Affiliate Link Portal.
Medicare Payment Denial- Kaiser Permanente Colorado implemented a new Standard Operating Procedure Effective 06/25/2020. All inpatient Medicare cases will be concurrently reviewed when the length of stay is greater than 10 days. If the case is no longer meeting medical necessity based on MCG criteria, the facility will be notified and given the opportunity to conduct a peer to peer with our Utilization Medical Director. If after the peer to peer the UMMD determines it is still not meeting inpatient medical criteria, a payment denial will be issued to the provider. This process was created to ensure KP members are utilizing inpatient hospital setting appropriately, and that they are transitioned to the correct lower level of care timely.
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