Health First Colorado providers request prior authorization (PAR) for outpatient services such as therapy, imaging, genetics labs, audiology, DME and supplies through Acentra Health, and this two-page form mirrors that request. Most providers must enter PARs in Acentra's Atrezzo portal; the PDF is only for new or revised PARs from providers approved to fax. It covers request type, providers, member, service, diagnoses and procedure lines.
The billing provider and the requesting or ordering provider are both identified by NPI or Health First Colorado ID; the requesting office completes the request, marking it new, a revision or a cancellation with the existing PAR number, and gives a contact name and phone.
Download the current version from the source each time; forms change without notice.
Outpatient Prior Authorization Request Form
Colorado Department of Health Care Policy and Financing (Health First Colorado); PAR reviews by Acentra Health takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Only if the provider has an approved fax exemption, requested with the Colorado Fax Exemption Form. Otherwise medical PARs must be submitted through Acentra Health's Atrezzo portal. The PDF states it is only for new or revised PARs from providers approved to fax.
The member's name, Health First Colorado ID and date of birth, whether the member has primary insurance and its name, and whether the member resides in a nursing facility. The setting is preset to outpatient, and the service type is chosen from the list printed on the form.
Acentra Health reviews medical PARs for the Colorado Department of Health Care Policy and Financing, including therapy, imaging, audiology, home health, supply and DME requests submitted through the Atrezzo portal or, for approved providers, by fax.