January 01, 2024

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 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 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


  • 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.


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 Visit Specialty Pharmacy – Medical Benefit Management (Provider Administered Drugs) for more information.


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