At RMHP, our goal is to make the prior authorization process as easy as possible. Read on to learn more.
About Prior Authorization
We will review your request to:
- Determine if the treatment or service is covered by a Member's health plan.
- Consider whether it is the right care, at the right time, from the right healthcare practitioner or provider
- Compare the Member's medical needs to criteria based on scientific evidence to make decisions
Prior authorization must be requested and review completed before the service is performed. Please contact Provider Services Monday through Friday, 8:00 a.m. to 5:00 p.m. for questions about the prior authorization process or receive benefit quotations. IFP at 888-478-4760, Medicare Advantage at 877-842-3210, DualCare at 800-701-9054, CHP+ at 877-668-5947, Rae/PRIME at 800-421-6204 and Rae Only (BH) at 800-421-6204.
How to Submit a Prior Authorization Request
Once all required information is received, you will receive your authorization decision within 48 hours.
Log in to the UHC provider portal
In order to gain access to submit preauth requests through the UHC Provider Portal, please fill out the spreadsheet and send via email to RMHPEssetteSupport@uhc.com. We apologize for this inconvenience.
View the Essette Training Manual
Prior Authorization for RMHP RAE & RMHP Prime Members
For RMHP RAE Member prior authorizations:
- Prior authorization requests for behavioral health services are submitted to UHCprovider.com
- Prior authorization requests for physical health services are submitted to Kepro following Health First Colorado rules.
- All PARs processed by the ColoradoPAR program are submitted through the Kepro web portal.
- Providers can contact Kepro at 720-689-6340.
For RMHP Prime Member prior authorizations:
- Prior authorization requests for behavioral health services are submitted to UHCprovider.com.
- Prior authorization requests for physical health services are submitted to UHCprovider.com.
For Prior Authorization requests, or any questions from Members/Providers about RMHP as the Region 1 RAE, call 800-421-6204.
Prior authorization is required for inpatient hospitalizations, partial hospitalizations, acute treatment units, short and long-term residential, day treatment, intensive outpatient programs, testing, and electroconvulsive therapy.
To submit a request to eviCore healthCare
- Advanced imaging procedures performed within Colorado must be made through eviCore healthCare online.
- Genetic testing must be submitted through eviCore healthCare online.
By clicking this link, you will be leaving the RMHP website. For additional information access the RMHP Lab Quick Reference Guide.
To submit a behavioral health service prior authorization request
- Access the secure RMHP provider portal, accessRMHP, for outpatient authorization requests
- Contact RMHP at 855-886-2832 for hospital notification
To submit a pharmacy or drug prior authorization request
Prior Authorization for Pharmacy
RMHP considers the Member's medical needs using criteria based on scientific evidence to make utilization management decisions. An RMHP Medical Director or Registered Pharmacist reviews all requests that do not meet these criteria. The Medical Director consults as needed with specialist physicians experienced in the type of care you requested.
The criteria used to make a decision are available, upon request, at no cost to the Member, practitioner, or provider. To receive a copy of specific criteria, call 800-834-0719, fax your request to 800-262-2567 or 970-255-5681, or send your request in writing to:
Rocky Mountain Health Plans
Attn Care Management
2775 Crossroads Blvd
Grand Junction, CO 81506
RMHP criteria for medical services and DME can be found by accessing the MCG Health tool. Please note, you will need to create a password and log in to access this tool.
For some types of prior authorization, RMHP works with other organizations who review these requests for us. You can view the criteria used by selecting the below links. Please note, by selecting these links, you will be leaving rmhp.org.
View criteria used by eviCore healthCare
Prior authorization request forms for Non-Contracted Providers only
Surgeries, procedures, tests
Prior authorization response times from RMHP
Decisions regarding prior authorization are made as quickly as possible. RMHP staff will inform you in writing the exact approved services.
Please anticipate the following response turn-around times from us:
Medicaid 10 days
Medicare 14 days
CHP+ 10 days
Commercial 5 days
Notification of Admission
The participating admitting facility is responsible to notify RMHP of an inpatient admission within 24 hours of admission. If a weekend or holiday is involved, then notification must occur the first business day following the weekend or holiday.
Notification of behavioral healthcare admissions for RMHP Commercial, Medicare, and CHP+ Members must be phoned to RMHP at 855-886-2832. This includes Acute Inpatient Psych; Inpatient Detox; Observation; Residential Treatment; Structured Outpatient/IOP; Partial Hospitalization; and Outpatient Detox. For notification of RMHP RAE or RMHP Prime Members, providers should call 888-282-8801.
Notification of transfer to another facility must be approved prior to the transfer.
When admitted out-of-network, the Member is responsible for notification to RMHP of an admission or transfer.
Prior Authorization Data
Certain services require prior authorization. The below data documents outline approvals and denials of prior authorization requests, in accordance with Colorado House Bill 19-1211.