- For Home Health Care and Durable Medical Equipment (DME) requests, Denver Health Medical Plan (DHMP) Utilization Management will allow submissions no later than five (5) business days after the start of care.
- For all other services a prior authorization form must be received prior to the start of services.
- Prior authorization request submissions must be completely and accurately filled out.
- Requests must be legible and free from any scratch outs or use of white out.
- If a DHMP member is admitted to your facility, you must notify DHMP within 24 hours. If you fail to notify DHMP during this window of time, the member’s admission and continued stay could be denied for “not timely notification."
EXTENSION OF SERVICES:
- DHMP will not modify a request once a decision has been rendered.
- For any modification (extended dates or additional visits) to the original authorization request requires a new submission.
- Each submission must be on a new prior authorization form with a new cover sheet.
- Do not submit duplicate requests as this will delay processing.
- Each prior authorization request submission will generate a new authorization number.
- Home care requests:
- DHMP requires a re-evaluation every 60 days.
- DHMP Medicaid Choice Members (wraparound benefit): DHMP covers acute care for the first 60 days. Long term care or care beyond 60 days is processed by the State. Please submit to the HCPF Provider Portal.
- Home Health orders must be signed by the provider prior to claims submission.
RETROSPECTIVE REQUESTS (POST SERVICE):
- Home Health or DME services submitted after five (5) business days from the start of care, or all other services submitted after the start of care will be considered retrospective requests.
- Prior Authorization requests for services which have already been submitted for claims payment please follow the instructions given by the Claims Department for denials.
Thank you for being a valued partner in serving our Denver Health Medical Plan members.