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 any 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
- Reproductive Health Services (provided by a CHP+ participating provider)
- Ambulance
- Routine Vision Exams - 1 visit/year
- Specialist visits (by a Participating Provider)
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- Inpatient admissions
- Therapies (PT, OT or ST, except reproductive health services)
- Ambulance services (except in life-threatening situations)
- Behavioral Health Services
Please refer to our General Authorizations document available for download here.
Services requiring a referral or authorization:
- Behavioral Health Visits
- Facilities
- Durable Medical Equipment (may require)
- Hearing Aids
- Developmental Evaluations
- Chemotherapy
- Surgery
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Providers must receive an authorization from Colorado Access for each referral prior to services being rendered. Retroactive authorizations will not be assigned unless approved by CHP+ or unless the referral is for urgent care. An authorization
will generally allow claims payment for a 90-day period from the date the authorization was issued,
assuming continued membership. Extensions in special circumstances may be granted, but are done on a
case-by-case basis. Please refer to the CHP+ State Managed Care Network Provider Manual for more details.
All CHP+ referral and authorizations can be requested either by telephone or by fax.
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Telephone |
Fax |
| Statewide |
800-414-6198 |
877-232-5967 |
| Metro Denver |
303-751-9051 |
303-755-4135 |
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 authorized
- Number of visits being authorized
- Specialist being referred to
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