Medical Policies
Medical policies act as guidance to help RMHP physicians determine whether a request for certain care is medically necessary. Effective March 1, 2025, Rocky Mountain Health Plans adopted the same medical policies and protocols used by UnitedHealthcare.
Please visit the UnitedHealthcare website to view the current medical policies.
Connecting Health Information
Across Colorado Communities
The Centers for Medicare & Medicaid Services (CMS) have a multistep requirement to help support interoperability. These standards support secure electronic sharing of health information, helping providers coordinate care, support public health reporting, and improve access to electronic medical records. This report is one piece of the requirement and is in connection with Medicare and Medicaid program participation. Publishing this information reflects an ongoing commitment to transparency, accountability, and meaningful use of health technology in the communities served. This annual report highlights the denial rate and appeal overturn rate (previous year) for services across all lines of business offered by RMHP as of January 1, 2026.
CMS Interoperability Report, 2025
Click the icon below to view the report.
The Centers for Medicare & Medicaid Services (CMS) have a multistep requirement to help support interoperability. These standards support secure electronic sharing of health information, helping providers coordinate care, support public health reporting, and improve access to electronic medical records. This report is one piece of the requirement and is in connection with Medicare and Medicaid program participation. Publishing this information reflects an ongoing commitment to transparency, accountability, and meaningful use of health technology in the communities served. This annual report highlights the denial rate and appeal overturn rate (previous year) for services across all lines of business offered by RMHP as of January 1, 2026.
In accordance with legislative requirements, we publish the clinical criteria used to inform coverage decisions. These criteria are nationally recognized and developed by independent nonprofit or professional medical societies. Learn more by visiting the links below.
- American Society of Addiction Medicine (ASAM) Criteria
- American Psychological Association (APA) Testing
- Early Childhood Service Intensity Instrument (ECS-II)
- EviCore by Evernorth Clinical Guidelines
- Level of Care Utilization System (LOCUS), American Association for Community Psychiatry (AACP)
- Child and Adolescent Level of Care/Service Intensity Utilization (CALOCUS-CASII) System Guide, American Academy of Child and Adolescent Psychiatry (AACAP)
In compliance with Colorado code §10-16-124.5, a law establishing Gold Carding for Individual and Family Plans (IFP), Rocky Mountain Health Plans posts annual detailed data on approval and denial decisions and information around provider authorization exemptions (also known as gold carding).