Frequently Asked Questions for Providers

Frequently Asked Questions for Providers

Do you have questions about RMHP? We've compiled the answers to some of our most commonly asked questions so you can find the answers you're looking for. If you have other questions, please contact us; we're happy to help.

Coverage

No. We believe the decision of which specialists may be needed should be one between you and your patients. Referrals are not required.

You can verify your patient's eligibility by logging into your provider portal and searching for your patient’s information online, or you can call Customer Service. We’re happy to help.

Log in to your portal     Contact Customer Service

Yes, for certain procedures. We do everything we can to make this process straightforward.

View services requiring preauthorization     Download Preauthorization Form

Claims

Check the status of a claim at any time by logging into your provider portal. You may also contact us during normal business hours for assistance.

Log in to your provider portal

We accept claims via mail, fax, or electronically. Simply complete the form and return it to us. Once we receive it, we’ll work quickly to process your claim.

Download a claim form

Network of Care

Below are general guidelines; however, you may always contact Customer Service with any questions.

Participating Providers

Medicare Part A plans
(HMO Standard, Value or Gold)
Bill Medicare first

Medicare Part B plans
Bill RMHP first

Non-Participating Providers

Medicare Part A plans
(HMO Standard, Value or Gold)

Bill Medicare first

Medicare Part B plans
Bill Medicare first

Once you file with Medicare, please file the claim with us as well so we can apply appropriate coinsurance and deductibles.

Commercial Plans

For patients with Medicare coverage through a commercial plan, Medicare may or may not be billed first.  It is best to contact Customer Service in these circumstances.  They will review the plan and advise the best way to file the claim.

Yes. We work exclusively with some providers and others give our Members discounts.  When referring your patients, keep these providers in mind.

Chiropractic
Landmark Healthcare Colorado, Inc. (exclusive provider)

Outpatient therapy
Theraphysics (exclusive provider)

Vision
Vision Service Plan (VSP) (discounted services for Medicare HMO)

Acupuncture
American Specialty Health Networks

Dental
Delta Dental

Behavioral Health

No. All non-emergent services provided by out-of-network behavioral health providers must be authorized prior to the service being provided.

Yes. Effective January 1, 2018, Optum will provide behavioral health and utilization management services for RMHP Medicare, CHP+, and Commercial Members. This change will not affect processes for RMHP Prime Members.

You can reach Optum’s behavioral health clinicians by calling 855-886-2832. Licensed clinicians are available 24/7, 365 days per year.

Licensed clinicians are available 24/7, 365 days per year.

Outpatient authorization requests may be submitted through the secure RMHP provider portal, accessRMHP. For hospital notification, please call 855-886-2832.

Log in to Access RMHP

For Commercial, Medicare, and CHP+ Members, please submit claims directly to RMHP, filing electronically or by paper. For RMHP Prime, you may bill the State's behavioral health organization, Colorado Health Partnership.