What is prior authorization?
Prior authorization (PA) means the carrier must approve certain care before it happens. A PA denial is different from a claim denial after care was already provided.
Overview for any state: Prior authorizations. This page is Colorado-only.
Confirm plan type: Colorado: Start Here.
Colorado PA deadlines
Colorado's main PA statute is C.R.S. § 10-16-112.5. Prescription drug PA has additional rules in C.R.S. § 10-16-124.5.
Medical services
After the carrier has what it needs to decide:
- Non-urgent: approve, deny, or say the request is incomplete within 5 business days
- Urgent: within 2 business days, but not longer than 72 hours after receipt
If the carrier says the request is incomplete, the provider generally has 2 business days to send more information; then the clock restarts.
If the carrier misses the deadline
In many cases the PA is deemed granted if the carrier fails to meet these notice deadlines (unless the provider did not send required follow-up information in time). Document when the request was submitted and every response from the carrier.
Provider PA exemptions
Carriers may offer alternatives—including PA exemptions—for providers with high approval rates (for example at least 80% approved over the prior 12 months). The carrier must reevaluate eligibility at least annually (C.R.S. § 10-16-112.5(4)(b)).
Prescription drugs
- Standard written/electronic requests: often 2 business days for urgent and 3 business days for non-urgent (C.R.S. § 10-16-124.5)
- Oral/fax/email: shorter timelines (often 1 day for urgent)
- Missing deadlines can result in deemed approval, similar to medical PA
Other protections
Colorado also limits step therapy in certain cancer and opioid situations (C.R.S. § 10-16-145.5) and requires carriers to post PA criteria publicly.
Where to look up PA rules
Match tools to the exact plan on the ID card. Major 2026 Marketplace carriers include:
- Kaiser Permanente (Colorado): healthy.kaiserpermanente.org/colorado
- Anthem Blue Cross Blue Shield: anthem.com/co
- Cigna Healthcare: cigna.com
- Rocky Mountain Health Plans: rmhp.org
- SelectHealth: selecthealth.org
- Denver Health Medical Plan: denverhealthmedicalplan.org
Health First Colorado
Medicaid PA and service denials follow managed care planrules and federal Medicaid standards—not C.R.S. § 10-16-112.5. Appeal to the member's health plan first; then a state fair hearing with the Office of Administrative Courts (often 60 days from the Notice of Action). See healthfirstcolorado.com — appeals.
If PA is denied
- Get the denial in writing with the clinical reason.
- Ask the treating clinician for records and a medical-necessity letter.
- Request first level review (internal appeal) per the denial instructions— Colorado internal appeals.
- If care cannot wait, ask for expedited review.
Building a strong appeal packet has a checklist.
Urgent care
Use the urgent PA timelines above and expedited internal/external review paths in internal appeals and external review. Colorado allows expedited external review to run at the same time as an expedited internal appeal in some cases (C.R.S. § 10-16-113.5(7)).
Emergency services have separate balance-billing and coverage protections; see your plan documents and expedited appeals on the Appeals Roadmap.