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Preauthorization Requirements

Preauthorization guidelines and downloadable forms are available below, for medical and pharmacy.

MEDICAL

The Rocky Mountain Health Plans preauthorization process helps members get the most successful health care treatment possible through:

  • the right care
  • from the right provider
  • at the right time
  • in the right setting

The treating doctor is responsible to ask for authorization for certain tests and treatments. RMHP staff will tell you in writing exactly what services are approved. Call RMHP Customer Service at 970-248-5036 or 800-854-4558 to ask about the preauthorization process or to get benefit quotations.

Some services that may require preauthorization are:

  • Hospital or other facility admissions
  • Home Health services
  • Durable Medical Equipment
  • Diagnostic tests such as PET scans
  • Services from a non-participating provider

Click here to see the list of services requiring preauthorization. Click here to see the list of durable medical equipment and medical supplies that require preauthorization.

IMPORTANT:

The preauthorization list is updated periodically and subject to change. Failure to get preauthorization may result in nonpayment for the services, and the member cannot be balance billed.

How to Submit a Preauthorization Request

  • Fax preauthorization requests as soon as you are aware the member requires services that need to be preauthorized.  Fax to 877-201-7302.
  • Also fax clinical notes with the request for review.
  • If you are directing a member to a noncontracted provider, submit a request for authorization before any service is provided.
  • The forms for requesting preauthorization must have all required fields completed, including applicable ICD, CPT, and/or HCPC codes.

Medical Preauthorization Forms

Click on the links below to download preauthorization request forms:

pdf Preauthorization Request Form (*Pharmacy preauthorizations must be completed on the appropriate, medication-specific PA Form below or they will not be processed)

pdf Home Health Authorization Form

pdf DME Authorization Form

Notification of Admission

The admitting facility is responsible to notify RMHP of an inpatient or observation admission within twenty four (24) hours of admission, unless a weekend or holiday is involved, in which case notification must occur the first business day following the weekend or holiday.

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PHARMACY

RMHP covers a wide variety of medications. The RMHP Formulary Guidelines include information about RMHP drug coverage. RMHP drug coverage is determined with active participation from an RMHP physician/pharmacy committee.

RMHP Outpatient Formulary Guidelines:

  • Include the coverage level for certain drugs (prior authorization, covered at what copayment tier, covered for what quantity of medication, not covered, etc.)
  • Encourage the use of appropriate generic drugs
  • Are updated regularly

Click here to see the RMHP Outpatient Formulary Guidelines.

Prescription Drugs Requiring Care Management Approval

Certain drugs are preauthorized by CM.  Click on the link to download the Preauthorization Form and fax to:

  • Rocky Mountain Health Plans 877-201-7302 or 970-254-5738
  • WINhealth Partners 877-825-3018

pdf Botox Myobloc

pdf Flolan

pdf Hyaluronic Acid Derivatives

pdf Immune Globulins

pdf Prolastin

pdf Remodulin

pdf Synagis

pdf TPN

Prescription Drugs Requiring Pharmacy Department Approval

Certain drugs are preauthorized by Pharmacy Department.  Click on the link to download the Preauthorization Form and submit to RMHP via:

  • Fax 970-248-5034
  • Call 970-248-5031 or 800-641-8921

pdf 17 Alpha-Hydroxyprogesterone

pdf Amevive and Raptiva

pdf Apokyn

pdf Avastin

pdf Chantix

pdf Desoxyn

pdf Emend

pdf Enbrel

pdf Erbitux

pdf Erectile Dysfunction

pdf Exjade

pdf Faslodex

pdf Fentanyl Patches

pdf Forteo

pdf Fuzeon

pdf Gleevec

pdf Growth Hormone

pdf Humira

pdf Infertility

pdf Inspra

pdf Iressa

pdf Kineret

pdf Letairis

pdf Lucentis

pdf Lyrica

pdf Nefazodone

pdf Nexavar

pdf Nexium

pdf OTC Nicotine

pdf Orencia

pdf Proferrin

pdf Provigil

pdf Prozac Weekly

pdf Remicade

pdf Revatio

pdf Revlimid

pdf Soliris

pdf Sprycel

pdf Sutent

pdf Tarceva

pdf Torisel

pdf Tracleer

pdf Triptans

pdf Tykerb

pdf Tysabri

pdf Vectibix

pdf Ventavis

pdf Xenical

pdf Xolair

pdf Zavesca

pdf Zolinza

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Behavioral Health

Prior to September 1, 2005, members who reside on the Front Range receive behavioral health care services from providers and facilities contracted with Horizon Behavioral Services. Contact Horizon Behavioral Health at 800-466-1120 to arrange for services for these members or to discuss claims payment issues for services rendered prior to September 1, 2005.

Effective September 1, 2005, members who reside on the Front Range receive behavioral health care services from providers and facilities contracted with Life Strategies. Contact Life Strategies at 800-716-1166 to arrange for services for these members or to discuss claims payment issues for services rendered after August 31, 2005.

Members who reside on the Western Slope receive behavioral health services from providers and facilities contracted with RMHP. Contact RMHP Customer Service at 970-248-5036 or 800-854-4558.

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