RMHP FAQs

Behavioral Health Providers FAQ

Q:
Are specialist referrals required?

A: No.  RMHP does not require referrals for specialty care from participating physicians or providers.

Q: Is preauthorization required?

A: Preauthorization is required for certain services. All preauthorization requests must be submitted on an RMHP form and faxed to our Utilization Management team. Learn more about preauthorization.

Q:  How do I check eligibility?

A: Patient eligibility can be researched through access|RMHP. You may also contact Customer Service 8:00 a.m. to 5:00 p.m., Mountain Time, Monday - Friday at 800-854-4558 or 970-248-5036 to verify eligibility.

Q: How do I check on the status of a claim?

A:
Check the status of a claim at any time by logging on to access|RMHP.  This tool is available 24 hours per day, seven days a week.  Alternatively, you may contact Customer Service 8:00 a.m. to 5:00 p.m., Mountain Time, Monday - Friday at 800-854-4558 or 970-248-5036 to check the status of your claim.

Q: How do I submit a claim?

A:
Claims must be submitted using the CMS 1500 or UB-92 form, mailed to Rocky Mountain Health Plans, PO Box 10600, Grand Junction, CO 81502. For additional questions, contact the RMHP EDI Coordinator at 800-311-5260 or 970-244-7893.

Q:  How do I know when to bill Medicare first?

A: HMO Standard, Value, or Gold Plans - all Part A providers bill claims for RMHP Medicare Members to the Medicare intermediary, then cross the claims over to RMHP for consideration of coinsurance and deductible. All non-participating providers bill Medicare first for RMHP Medicare Members, regardless of whether they are Part A or Part B providers. Participating Part B providers bill RMHP directly.

Commercial RMHP plans - Medicare may or may not be primary. Contact Customer Service 8:00 a.m. to 5:00 p.m., Mountain Time, Monday - Friday at 800-854-4558 or 970-248-5036 with questions.

Q: Do you use any subnetworks that I should know about?

A: Yes. All Members with a chiropractic benefit must use Landmark Healthcare Colorado, Inc., chiropractors.  Theraphysics is the exclusive provider network for outpatient therapy services. Vision Service Plan, or VSP, (vision) and American Specialty Health Networks (accupuncture) provide access to discounted services for our Medicare HMO Members. Delta Dental offers a dental plan to complement some RMHP medical plans.

Q: How do I contact Customer Service?

A: You can call Customer Service 8:00 a.m. to 5:00 p.m., Mountain Time, Monday - Friday at 800-854-4558 or 970-248-5036.