September 21, 2023

Rocky Mountain Health Plans medical criteria is available

Rocky Mountain Health Plans, a UnitedHealthcare affiliate, has established medical guidelines and criteria to help your patients get the best care possible. One of the ways they use these guidelines, which are based on clinical evidence, is to help make determinations on prior authorizations and other benefit decisions.

Affirmative statement for medical decisions

The Rocky Mountain Health Plan affirmative statement outlines the guidelines they use to make benefit and medical necessity decisions that affect your patients. Specifically, it states the following:

  • We make decisions based on appropriateness of care and services and existence of coverage
  • We don’t reward decision-makers for issuing denials of coverage
  • Compensation for utilization management decision-makers does not encourage decisions that result in underutilization

Where to find the criteria and guidelines

The criteria used to make decisions is available upon request by one of the following methods at no cost to you or the member:

  • Online: MCG Health
  • Phone: 800-346-4643 x2092
  • Mail: Rocky Mountain Health Plans
             Attn: Utilization Management
             2775 Crossroads Blvd.
             Grand Junction, CO 81506


If you have questions, please contact Jessica Segrest, clinical coordinator for Rocky Mountain Health Plans, at 970-628-7016, 8 a.m.–5 p.m. CT.

Finding news icon

Discover more news

Personalized news icon

Get personalized news