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UnitedHealthcare Community Plan of Colorado | Rocky Mountain Health Plans

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.

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State news, bulletins and alerts

Rocky Mountain Health Plans resources

Prior authorization and notification


Access prior authorization and notification information for Medical and Behavioral Health

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Medical and drug policies


See Medical and Drug Policies

View medical policies
View drug policies

Reimbursement policy updates


Search and review current Colorado reimbursement 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

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Clinical guidelines


Evidence-based clinical guidelines for quality and health management programs

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All full-benefit Health First Colorado members, excluding members enrolled in the Program for All-Inclusive Care for the Elderly (PACE), are enrolled in the Accountable Care Collaborative (ACC) and assigned to 1 of 7 Regional Accountable Entities (RAEs). 

Rocky Mountain Health Plans is the RAE for Region 1 in the state and manages members’ physical and behavioral health by performing duties previously held by the Regional Care Collaborative.

Below, you will find information about the value-based payment program for primary care medical providers in RAE Region 1.

  • Colorado DSNP - 800-701-9054 
  • Colorado Medicaid - 800-421-6204 
  • Colorado CHIP - 877-668-5947 
  • Colorado IFP/Exchange - 888-478-4760

For questions about Credentialing and Attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

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.

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.

Visit UHCCommunityPlan.com/CO for 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 at UHCCommunityPlan.com/CO and myuhc.com/communityplan.

CommunityCare

The best way for primary care providers (PCPs) to view and export the full 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
  • View most Medicaid and Medicare Special 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 our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.

Go to CommunityCare Now
CommunityCare Overview

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. If you 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 at 1-844-359-7736 or visit uhc.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 Policies and clinical guidelines page on the left.