UnitedHealthcare Community Plan of Colorado Rocky Mountain Health Plans
We know you don't have time to spare, so we put all the UnitedHealthcare Community Plan resources you need in one place. Use the navigation on the left to quickly find what you're looking for. Be sure to check back frequently for updates.
Rocky Mountain Health Plans - transition updates and information
Bookmark this page and check back daily for urgent updates and information.
Today’s important information
Colorado Medicaid (Health First Colorado) members not enrolled in Rocky Mountain Health Plans PRIME, are not showing as eligible on claims or prior authorization requests submitted through UHCprovider.com. We’re working to correct this error. In the meantime, please use Provider Express to complete all behavioral health-related activities. If this is your first time using Provider Express, please register your account using your One Healthcare ID and reference the First Time Registration for Provider Express training.
Please continue to submit prior authorization requests as required
Review the Rocky Mountain Health Plans Prior Authorization and Notification Guide for information about submission issues you may experience.
Out-of-network message
If you are seeing an out-of-network message that you believe is incorrect use the following steps:
- If searching by group, please search by individual provider
- If searching by individual provider, please try searching by group
- If utilizing the drop down and selecting only available option with an out of network result, please contact CSCommunication@rmhp.org
- Colorado DSNP - 800-701-9054
- Colorado Medicaid - 800-421-6204
- Colorado CHIP - 877-668-5947
- Colorado IFP/Exchange - 888-478-4760
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
If you're interested in joining our network or recredentialing with us, we’ll work with you to verify your qualifications, practice history, certifications and registration to practice in a health care field. To get started:
- Visit our Get Started page to begin the process
- Review our Get Credentialed page to access resources and information about the process
- Take our Getting Started with UnitedHealthcare training course for new care providers. Whether you are new to our network, have a new employee or simply need a refresher, this self-paced course is designed to give you what you need to get started with us.
Overview
The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:
- Promote quality of care
- Strengthen efforts to reform the delivery of care to individuals covered under Medicaid and Children’s Health Insurance Plans (CHIP)
- Strengthen program integrity by improving accountability and transparency
Enhance policies related to program integrity With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.
Visit UHCCommunityPlan.com/CO for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Member plan and benefit information can also be found at UHCCommunityPlan.com/CO and myuhc.com/communityplan.
Coming soon
When you report a situation that could be considered fraud, you’re doing your part to help save money for the health care system and prevent personal loss for others. If you suspect another provider or member has committed fraud, waste or abuse, you have a responsibility and a right to report it.
Taking action and making a report is an important first step. After your report is made, we will work to detect, correct and prevent fraud, waste, and abuse in the health care system.
Call us at 1-844-359-7736 or visit uhc.com/fraud to report any issues or concerns.
UnitedHealthcare Dual Complete® Special Needs Plan
UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.
Health Insurance Portability and Accountability Act (HIPAA) Information
HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.
Integrity of Claims, Reports, and Representations to the Government
UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. View our policy.
Disclaimer
If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. To see updated policy changes, select the Bulletin section at left.