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.