Colorado Rocky Mountain Health Plans Prior Authorization Lookup
- Colorado Rocky Mountain Health Plans coverage criteria
- All Colorado Rocky Mountain Health Plans policy updates
Latest Colorado Rocky Mountain Health Plans prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Adult Cardiac Imaging Guidelines (For Ohio Only)Radiology imaging coverage determination guideline governing adult cardiac imaging services for UnitedHealthcare Community Plan members in Ohio; establishes evidence-based use, applicability, and evaluation framework for imaging requests.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Adult Head Imaging Guidelines (Ohio) — Radiology Imaging Coverage Determination GuidelineRadiology imaging coverage determination guideline governing adult head imaging requests for UnitedHealthcare Community Plan members in Ohio; outlines evidence-based imaging criteria, modality selection, exclusions, and documentation/prior authorization expectations.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Adult Neck Imaging Guidelines (Ohio)Coverage and medical necessity criteria for radiology imaging of the adult neck for UnitedHealthcare Community Plan members in Ohio. Applies to providers requesting imaging services in the state of Ohio and explains guideline development and application.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Adult Spine Imaging Guidelines (Ohio) — Radiology Imaging Coverage Determination GuidelineCoverage and medical necessity criteria for advanced and conventional spine imaging modalities in adults, applicable only to UnitedHealthcare Community Plan members in the state of Ohio.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Breast Imaging Guidelines (Ohio) — Radiology Imaging Coverage Determination GuidelineState-specific radiology imaging coverage guideline governing breast imaging services for UnitedHealthcare Community Plan members in Ohio; applies to medical necessity determinations per Ohio Administrative Code 5160-1-01.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric Abdomen Imaging Guidelines (For Ohio Only)Radiology imaging coverage guideline for pediatric abdominal imaging that applies to UnitedHealthcare Community Plan members in Ohio and governs medical necessity determinations for abdominal imaging procedures.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric Cardiac Imaging Guidelines (UnitedHealthcare Community Plan — Ohio)Guideline governing radiology imaging coverage decisions for pediatric cardiac imaging for UnitedHealthcare Community Plan members in Ohio. It directs evaluation of medical necessity and applicability of imaging services for pediatric cardiac conditions.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric Chest Imaging Guidelines (Ohio) — Radiology Imaging Coverage Determination GuidelineGuideline governing coverage determinations for pediatric chest imaging services for UnitedHealthcare Community Plan members in Ohio, including medical necessity and investigational status for advanced imaging modalities in children.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric Musculoskeletal Imaging Guidelines (Ohio)Radiology imaging coverage determination guideline governing pediatric musculoskeletal imaging services for UnitedHealthcare Community Plan members in Ohio; defines application, development, and evidence standards used to evaluate medical necessity.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric Neck Imaging Guidelines (Ohio)Coverage and medical necessity criteria for radiology imaging of the pediatric neck for UnitedHealthcare Community Plan members in Ohio.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines (Ohio)Radiology imaging coverage and medical necessity guidelines for pediatric peripheral vascular disease imaging as applied to UnitedHealthcare Community Plan members in Ohio.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Pediatric and Special Populations Spine Imaging Guidelines (For Ohio Only)Radiology imaging coverage determinations for pediatric and special population spine imaging requests applicable to UnitedHealthcare Community Plan members in Ohio. Governs medical necessity review and applicability of these imaging guidelines for Ohio only.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Arcalyst (rilonacept) prior authorization and coverageDefines prior authorization, initial and reauthorization criteria for Arcalyst (rilonacept) for Colorado Rocky Mountain Health Plans members; applies to providers requesting coverage under the plan's clinical pharmacy program.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Camzyos (mavacamten) prior authorization / medical necessityPolicy governing prior authorization and medical necessity criteria for Camzyos (mavacamten) for adults with symptomatic NYHA class II-III obstructive hypertrophic cardiomyopathy; applies to Colorado Rocky Mountain Health Plans pharmacy benefit and prescribers seeking coverage.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Clinical Pharmacy Prior Authorization and Coverage Criteria — Afinitor (everolimus)This document sets Colorado Rocky Mountain Health Plans' clinical pharmacy prior authorization and coverage criteria for Afinitor (everolimus), describing indications, initial and reauthorization requirements, and pediatric processing rules for members.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Cosentyx (secukinumab) prior authorization and medical necessityDefines Colorado Rocky Mountain Health Plans' prior authorization and medical necessity requirements for Cosentyx (secukinumab) prefilled syringe or Sensoready pen across indicated dermatologic and rheumatologic conditions for members; applies to prescribers seeking coverage for this medication.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Cosentyx (secukinumab) prior authorization — coverage criteriaDefines prior authorization, initial approval, and reauthorization criteria for Cosentyx (secukinumab) prefilled syringe or Sensoready pen for multiple indications under Colorado Rocky Mountain Health Plans.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Daraprim (pyrimethamine) — Prior Authorization and Medical NecessityDefines prior authorization and medical necessity criteria for outpatient coverage of Daraprim (pyrimethamine) for Colorado Rocky Mountain Health Plans members, including indications, documentation, and duration of authorization.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Daybue (trofinetide) prior authorizationDefines prior authorization and reauthorization requirements for Daybue (trofinetide) for treatment of Rett syndrome in members of Colorado Rocky Mountain Health Plans; applies to providers requesting coverage for this medication.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Epidural Steroid Injections for Spinal Pain (for Ohio Only)This policy governs medical necessity, coverage criteria, and coding for epidural steroid injections (ESIs) for radicular spinal pain and applies only to Ohio; it informs providers and prior authorization reviewers about requirements for coverage under Colorado Rocky Mountain Health Plans.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Fabhalta (iptacopan) prior authorization — Coverage CriteriaDefines prior authorization and reauthorization criteria for Fabhalta (iptacopan) for adults with PNH, primary IgA nephropathy (IgAN) at risk of rapid progression, and complement 3 glomerulopathy (C3G); applies to Colorado Rocky Mountain Health Plans pharmacy benefits.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Fabhalta (iptacopan) — Prior authorization and medical necessity criteriaPrior authorization and medical necessity criteria for Fabhalta (iptacopan) for adults with PNH, primary IgA nephropathy (IgAN) at risk of rapid progression, and complement 3 glomerulopathy (C3G); applies to Colorado Rocky Mountain Health Plans pharmacy benefit.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Fotivda (tivozanib) — Prior Authorization and Coverage CriteriaPrior authorization and coverage criteria for Fotivda (tivozanib) for treatment of relapsed or refractory advanced renal cell carcinoma; affects prescribers and members covered by Colorado Rocky Mountain Health Plans and UnitedHealthcare Pharmacy prior authorization programs.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Florida Only)Defines documentation, prior authorization, visit-approval criteria, and provider requirements for outpatient occupational, physical, and speech therapy for members in Florida; governs evaluation, re-evaluation, initial and continuation visit authorizations and exclusions.All Colorado Rocky Mountain Health Plans updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Methyldopa — Prior Authorization / Medical NecessityDefines prior authorization and medical necessity criteria for coverage of methyldopa under Clinical Pharmacy Programs for Colorado Rocky Mountain Health Plans members.All Colorado Rocky Mountain Health Plans updates
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Tool Description
Search Colorado Rocky Mountain Health Plansprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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