Rocky Mountain Health Plans: Outpatient prior authorization changes
Starting March 1, 2024, you’ll submit prior authorization requests for non-oncology, physician-administered drugs (PADs) received in an outpatient setting through the UnitedHealthcare Provider Portal. This change is now part of the UnitedHealthcare Specialty Guidance Program (SGP), an evidence-based prior authorization request tool. The following benefit plans are affected:
- Rocky Mountain Health Plans Medicaid PRIME and CHP+
- Rocky Mountain Health Plans CareAdvantage Value
- Rocky Mountain Health Plans CareAdvantage Enhanced (UnitedHealthcare® Medicare Advantage)
- UnitedHealthcare Rocky Mountain Dual Complete CO-S003 (HMO-POS D-SNP)
- Monument One
- Colorado Doctors Plan
- Rocky Mountain Valley Health Plan
- Rocky Mountain Sky Plan
- Sky Colorado Option
- Monument Health
How to submit your requests
- Sign in to the UnitedHealthcare Provider Portal at UHCprovider.com. Click Sign In in the top-right corner to log in using your One Healthcare ID and password.
- If you’re a new user, go to UHCprovider.com/access to get started
- Click the Prior Authorization tab on the left side of the page and choose Specialty Pharmacy
- Enter the required information
What this means for existing prior authorization submissions
Prior authorizations submitted before March 1, 2024, will remain in effect. You won’t need to submit a new request until the existing authorization expires, or you change the member’s therapy. Changes in therapy include the following:
- Dose
- Frequency of administration
- Place of therapy
Resources
- Coverage determinations: We’ll make determinations for prior authorization requests based on UnitedHealthcare clinical policy requirements for coverage. Appeal rights may apply.
- Training: See our prior authorizations course to learn more.
Questions?
For questions, please call us at 888-397-8129, 8 a.m.–5 p.m. local time, Monday–Friday. You can also email us at specialtyguidanceprogram@optum.com. Visit Specialty Pharmacy – Medical Benefit Management (Provider Administered Drugs) for more information.
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