Provider Frequently Asked Questions
RMHP does not require referrals for specialty care from participating physicians or providers.
Preauthorization is required for certain services. All preauthorization requests must be submitted on an RMHP form and faxed to our Utilization Management team. Click here for further details about preauthorization.
Patient eligibility can be accessed through
Access RMHP. If you are already registered,
click here to access. To learn more or to register, go to
www.rmhp.org,
Access RMHP for Providers on the home page. You may also verify eligibility by calling Customer Service at 800-854-4558 or 970-248-5036.
How do I check on the status of a claim?
Log on to Access RMHP, and you can check the status of a claim 24/7. Call Customer Service at 800-854-4558 or 970-248-5036.
How do I submit a claim?
Claims must be submitted on a CMS 1500 or UB-92. Mail claims to Rocky Mountain Health Plans, PO Box 10600, Grand Junction, CO 81502. To obtain information about electronic submission of claims, please click here or call the EDI Coordinator at 800-311-5260 or 970-244-7893. If you are already a registered user, go to https://providers.rmhp.org.
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.
For Members with a Commercial RMHP plan, Medicare may or may not be primary. Refer to the Provider Manual for complete details and exceptions or contact Customer Service at 800-854-4558 or 970-248-5036.
All Members with a chiropractic benefit must use Landmark Healthcare Colorado, Inc., chiropractors. Along the Front Range, Life Strategies is the exclusive provider for behavioral health services and 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.
You can contact RMHP Customer Service Monday through Friday from 8:00 a.m. to 5:00 p.m. at 800-854-4558 or 970-248-5036.
Additional Resources
Interested in submitting claims electronically? Click here.
Colorado Immunization Registry
ClarEDI HIPAA Code Sets
Link to ePocrates
Center for Medicare and Medicaid Services
Council for Affordable Quality Healthcare
Think Cultural Health
Colorado Foundation for Medical Care