We know you don't have time to spare. That’s why we put all the Rocky Mountain Health Plans 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.
Are you a member looking for health plan or provider information?
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State news, bulletins and alerts
- Medicaid: Genetic testing covered for prostate cancer
- Medicaid PRIME: Update prior authorizations or prescriptions to continue member care
- Rocky Mountain Health Plans medical criteria is available
- Oncology drug prior authorization update
Rocky Mountain Health Plans resources
Prior authorization and notification
Access prior authorization and notification information for Medical and Behavioral Health
Learn more
Reimbursem*nt policy updates
Search and review current Colorado reimbursem*nt policies
View policies
Behavioral health resources
Information about Regional Accountability Entity (RAE), forms, claims and training
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Care provider manuals
Access Colorado medical and behavioral health care provider manuals
Learn more
Clinical guidelines
Evidence based clinical guidelines for quality and health management programs
View guidelines
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Contact us
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- Colorado DSNP - 800-701-9054
- Colorado Medicaid - 800-421-6204
- Colorado CHIP - 877-668-5947
- Colorado IFP/Exchange - 888-478-4760
Credentialing and attestation
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For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
Join our network
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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.
Medicaid managed care rule
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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.
Member information: Current medical plans, ID cards, provider directories, dental & vision plans
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Visit UHCCommunityPlan.com/COfor 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 atUHCCommunityPlan.com/COandmyuhc.com/communityplan.
PCP membership reports
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CommunityCare
The best way for primary care providers (PCPs) to view and export thefull member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:
- Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the state in order to remain eligible to receive Medicaid benefits
- See a complete list of all members, or just members added in the last 30 days
- Export the roster to Microsoft Excel
- View most Medicaid and MedicareSpecial Needs Plans (SNP) members’ plans of care and health assessments
- Enter plan notes and view notes history (for some plans)
- Obtain HEDIS information for your member population
- Access information about members admitted to or discharged from an inpatient facility
- Access information about members seen in an emergency department
For help using CommunityCare feature on the UnitedHealthcare Provider Portal, please see ourQuick Reference Guide.If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.
CommunityCare Overview
Reporting health care fraud, waste and abuse
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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.Ifyou 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 at1-844-359-7736or visituhc.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.
Learn more
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.
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.
