Search
Purpose and Disclaimer
To provide clinical guidance for determining what medical services, procedures, devices, and drugs may be eligible for coverage and to evaluate whether a medical procedure or equipment is medically necessary. Clinical coverage guidelines are reviewed and presented to the Utilization Management Committee (UMC) annually.
Providers are responsible for verifying eligibility and benefits before providing services to all Denver Health Medical Plan (DHMP) members. Please refer to the member’s benefit document for specific coverage information. If there is a difference between this general information and the member’s benefit document, the member’s benefit document will be used to determine coverage.
Coverage determinations for individual requests require consideration of:
- The terms of the applicable benefit document in effect on the date of service.
- Any applicable laws and regulations.
- Any relevant collateral source materials including coverage policies.
- The specific facts of the situation.
Contact DHMP Health Plan Services at 303-602-2100 to discuss plan benefits more specifically.