Rocky Mountain Health Plans - PRIME

If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-800-421-6204, TTY 711. We are open Monday through Friday, 8 am to 5 pm MST.

Already a member?

You have access to our member-only website. Print ID cards and more. View our Member Website 

It's important for us to ensure our Members, partners, and stakeholders have the information needed to learn about our Regional Accountable Entity initiative. Please, please find the relevant reports and resources.

• Governance Plan
• Annual Quality Report
• Annual Quality Improvement Plan
• Population Management Strategic Plan
• Annual Network Management Strategic Plan (Includes Practice Support Plan and Administrative Payment Report)
• Regional Program Improvement Advisory Council Materials/Minutes
• Member Advisory Council Materials/Minutes

CirrusMD provides the fastest connection to a board-certified doctor - answers to your healthcare questions are a text message away. Securely text, send photos, or video chat with a provider in the app right from your smartphone or computer. CirrusMD is available 24/7 for our Regional Organization (RAE), PRIME, CHP+ and DSNP Members at no cost.

Learn more about CirrusMD for RMHP

What Can CirrusMD Help With?

• General Health Questions: Do you have questions about medication side effects, lab orders/results, recommended health screens, or follow up questions after recent in-person care?
• Questions About Where to Receive Care: Before you schedule an in-person appointment or go to the ER, chat with a doctor instantly on CirrusMD.
• Urgent Care: coughs, fevers, sore throat, stomach pain, rashes, allergic reactions, animal/insect bites, and pediatric care such as common viral infections
• Mental Health: anxiety, depression, stress, insomnia
• Chronic Care and Prevention: Is your asthma under good control? Questions about weight loss, smoking cessation, managing diabetes, hypertension, or acne?
• Women’s Health: birth control, irregular bleeding, urinary tract infections, wellness

The Family Healthline is a statewide telephone information and referral service (English and Spanish) that provides callers with the eligibility criteria and resources for Colorado health care programs that provide services to pregnant women, children and individuals. Resources include indigent medical care, vision, dental, mental health care programs and nutrition programs. Information is also available about services for emergency shelters, domestic violence counseling, victim assistance programs, legal aid, housing assistance, abstinence education, family planning and other services as needed. Call 1-800-688-7777 for more information.

If you need help finding financial assistance, food pantries, medical care, and other free or reduced-cost help starts here: Find HELP.org

Call 211 — for easy access to information about health and human services, including local transportation

These Clinical Practice Guidelines (“Guidelines”) are not meant to replace the clinical judgment of a Member’s physician or other professional health care provider (collectively, “Providers”). As such, these Guidelines do not establish a standard of care or practice or replace appropriate clinical decision-making. These Guidelines must always be used in the context of a health care Provider's clinical judgment in the care of a particular patient.

For that reason, Guidelines may be viewed as an educational tool to provide information and assist Members and Providers in choosing appropriate health care for specific clinical conditions and diagnoses. Deviations from the Guidelines may be necessary and appropriate in certain individual circumstances.

Publication of these guidelines is not a promise or guarantee of coverage. Individuals should review their coverage documents or contact RMHP Member Services at 1-800-421-6204 to determine what health care services are covered benefits and if other conditions or limits of coverage apply.

For more information around clinical guidelines, please visit: Clinical Practice Guidelines for RMHP

Colorado Statewide Standardized Utilization Management (SSUM) Guidelines - English

Colorado Statewide Standardized Utilization Management (SSUM) Guidelines - Español

An advance directive is a type of written instruction about the health care to be followed if you become unable to make decisions about medical treatment. You prepare your Advance Directive when you are able to make these decisions. Then, if there is a time when you are unable to make health treatment decisions, the directive will be followed. These instructions do not take away your right to decide what you want, if you are able to do so at the time a decision is needed.

An advance directive is a type of written instruction about the health care to be followed if you become unable to make decisions about medical treatment. You prepare your Advance Directive when you are able to make these decisions. Then, if there is a time when you are unable to make health treatment decisions, the directive will be followed. These instructions do not take away your right to decide what you want, if you are able to do so at the time a decision is needed.

RMHP is committed to protecting the confidentiality of your medical information to the fullest extent of the law. In addition to the laws that govern your privacy, RMHP has its own privacy policies and procedures to help protect your information. If you would like a copy of RMHP’s privacy policies and notices, visit https://www.uhccommunityplan.com/privacy-policy, refer to Notice of Privacy Practices in  the Member handbook, or call Member Services.

It is your right

• To get information about RMHP and its services, doctors, and health care providers and to get information about your rights and responsibilities
• To be treated with respect and with recognition of your dignity and right to privacy
• To accept or refuse medical treatment to the extent provided by Colorado state law and to participate in making decisions about your health care
• To have open discussion with health care providers about appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage, and presented in a manner appropriate to your condition and ability to understand 
• To make appeals, and to bring complaints to RMHP, the Insurance Commissioner of the State of Colorado, or the Department of Health Care Policy and Financing
• To be furnished health care services in accordance with federal health care regulations for access and availability, care coordination and quality
• To expect all communications regarding your care to be kept confidential as required by law
• To freely exercise your rights without being treated differently
• To be free from the use of physical restraint or being isolated. These methods may not be used to make you cooperate, to punish you, for the ease of the caregiver, or as a way of getting back at you.
• To get family planning services from any Health First Colorado provider, in or out of RMHP’s network, with no referral
• To request and receive your medical records and to have them changed according to federal law
• To get a second opinion without a referral
• To be free from discrimination based on race, color, national origin, age, disability, sex, sexual orientation, or gender identity
• To make recommendations regarding RMHP’s rights and responsibilities policy
• To use any hospital or other setting for emergency care

It is your responsibility

• To choose a Primary Care Physician (PCP) for each member of your family and to let that PCP know of any Advance Directive regarding your medical care
• To let your PCP direct your care with specialists and other health care providers, except in cases of medical emergencies, urgent care when outside the service area, obstetrical or gynecological care, and eye care
• To learn about your RMHP health care benefits, procedures, and limitations and to be cooperative and considerate with health care providers and staff
• To notify Member Services of membership or address changes, marriage, birth of a child, or adoption of a child. (You must also notify Health First Colorado of any address changes. You can do this through your PEAK app, co.gov/PEAK.)
• To take responsibility for copayments and costs for certain health care services and any services that are not covered by Health First Colorado
• To understand your health problems and participate in making treatment goals
• To provide the health care provider with all information needed for you to receive appropriate care
• To follow the plans and instructions for care that you and your provider agreed on
• To tell your providers about any Advance Directives about your health care
• To tell RMHP about any other insurance you may have, including Medicare
• To follow any protocols of a responsible third party payor (such as other insurance) prior to receiving any non-emergency services
• To provide RMHP with written notice after filing a claim or action against a third party responsible for your illness or injury
• To file a complaint or grievance, please follow the rules as described in the Appeal and grievance section of this handbook

You have many rights as an RMHP Colorado PRIME member. You have the right to complain about RMHP. You have the right to complain about your care. You, your provider or a Designated Client Representative may complain about anything you are unhappy about or have a problem with. To get more information about appeals and grievances call Member Services.

If you need help with the information in any RMHP document, including written/ oral translation; or in a different format like large print or as an audio file, we can help you at no cost. You can get help by calling Rocky Mountain Health Plans (RMHP) at 800-421-6204 or State Relay 711 for callers with speech or hearing disabilities.

Si necesita ayuda con la información en este documento incluida la traducción oral/escrita, un formato diferente (como letra grande), o un archivo de audio, podemos ayudarlo sin costo. Puede obtener ayuda llamando Rocky Mountain Health Plans (RMHP) al 800-421-6204 o State Retransmisión 711 para personas con discapacidad auditiva o del habla.

RMHP wants to help our Members get care from providers close to where you live.

For Medicaid we strive to make sure there are at least two behavioral health providers within your zip code or within these distances: 

• In urban areas, within a maximum time of 30 minutes or a maximum distance of 30 miles 
• In rural areas, within a maximum time of 60 minutes or a maximum distance of 60 miles 
• In frontier areas, within a maximum time of 90 minutes or a maximum distance of 90 miles

For Medicaid we strive to make sure there are at least two physical health providers within your zip code or within these distances: 

• In urban areas, within a maximum time of 30 minutes or a maximum distance of 30 miles 
• In rural areas, within a maximum time of 45 minutes or a maximum distance of 45 miles 
• In frontier areas, within a maximum time of 60 minutes or a maximum distance of 60 miles

Medicaid providers should follow the following appointment timeliness standards:

• Behavioral Health
  • Urgent Care – within 24 hours of initial identification of need
  • Outpatient follow-up – within 7 days after discharge from a hospital
  • Non-urgent, symptomatic care visit – within 7 days after the request
  • Well Care Visit – within 1 month after the request, or in accordance with the Bright Futures Schedule. 
  • Emergency behavioral health care
    • By phone within 15 mins after initial contact,
    • In person within 1 hour of contact in urban and suburban areas
    • In person within 2 hours of contact in rural and frontier areas
  • Non-urgent, symptomatic behavioral health services – within 7 days after request
  • Member should not be place on a waiting list for any initial routine service requests
• Physical Health
  • Emergency – 24 hours a day, 7 days a week
  • Urgent Care – within 24 hours of initial identification of need
  • Outpatient follow-up – within 7 days after discharge from a hospital
  • Non-urgent, symptomatic care visit – within 7 days after the request
  • Well Care Visit – within 1 month after the request, or in accordance with the Bright Futures Schedule. 
  • Members should not be placed on a waiting list for any initial routine service requests