Colorado: Oncology drug prior authorization update

Affects various health care plans

Effective Nov. 1, 2023, we are changing how you submit prior authorization requests for chemotherapy drugs received in an outpatient setting. These updates come as a result of ongoing expansion of our Cancer Guidance Program (CGP).

The changes will now allow you to submit via the UHC Provider Portal. This affects the following benefit plans:

Rocky Mountain Health Plans Medicaid PRIME and CHP+
Rocky Mountain Health Plans CareAdvantage Value
Rocky Mountain Health Plans CareAdvantage Enhanced (Medicare Advantage)
Rocky Mountain Health Plans DualCare Plus (DSNP)
Monument One
Colorado Doctors Plan
Rocky Mountain Valley Health Plan
Rocky Mountain Sky Plan
Sky Colorado Option
Monument Health

How to submit a request

You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

Go to UHCprovider.com and click Sign In at the top-right corner
Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
In the menu, select Prior Authorizations
Scroll down to Create a new notification or prior authorization request and click Create New Submissions
Enter the required information and submit

If we don’t receive a prior authorization request before the date of service, we’ll deny the claim, and you won’t be able to balance bill members.

Resources

Coverage determinations: We’ll make determinations for prior authorization requests based on UnitedHealthcare clinical policy requirements for coverage. Appeals rights may apply.
Training: To learn more, visit our Prior Authorization and Notification guide