August 01, 2023
Colorado: Oncology drug prior authorization update
Affects various health care plans
Effective Nov. 1, 2023, we are changing how you submit prior authorization requests for chemotherapy drugs received in an outpatient setting. These updates come as a result of ongoing expansion of our Cancer Guidance Program (CGP).
The changes will now allow you to submit via the UHC Provider Portal. This affects the following benefit plans:
- Rocky Mountain Health Plans Medicaid PRIME and CHP+
- Rocky Mountain Health Plans CareAdvantage Value
- Rocky Mountain Health Plans CareAdvantage Enhanced (Medicare Advantage)
- Rocky Mountain Health Plans DualCare Plus (DSNP)
- Monument One
- Colorado Doctors Plan
- Rocky Mountain Valley Health Plan
- Rocky Mountain Sky Plan
- Sky Colorado Option
- Monument Health
How to submit a request
You can submit a prior authorization request through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and click Sign In at the top-right corner
- Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
- Scroll down to Create a new notification or prior authorization request and click Create New Submissions
- Enter the required information and submit
If we don’t receive a prior authorization request before the date of service, we’ll deny the claim, and you won’t be able to balance bill members.
Resources
- Coverage determinations: We’ll make determinations for prior authorization requests based on UnitedHealthcare clinical policy requirements for coverage. Appeals rights may apply.
- Training: To learn more, visit our Prior Authorization and Notification guide
Questions?
If you have questions, please call 888-397-8129 or email unitedoncology@uhc.com. For more information, visit the Oncology Prior Authorization and Notification page.
