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.