• the right care
• from the right provider
• at the right time
• in the right setting

The treating doctor is responsible to ask for authorization for certain tests and treatments. Denver Health Medical Plan  staff will tell you in writing exactly what services are approved. Call Denver Health Medical Plan Customer Service at 720-956-2100 to ask about the preauthorization process or to get benefit quotations.

Prior Authorization is required for, but not limited to, the following services:

• Durable medical equipment
• Genetic testing
• Home health care, including IV therapy
• All hospital stays, including alcohol or substance abuse-related stay
• Outpatient surgery, except those procedures performed in a physician’s office
• Prescription drugs that require prior authorization as listed in the DHMP formulary
• Renal dialysis
• Skilled nursing facilities
• Transplant evaluations and procedures
• Hospice

IMPORTANT:

The preauthorization list is updated periodically and subject to change. Failure to get preauthorization may result in nonpayment for the services, and the member cannot be balance billed.

How to submit a preauthorization request

• Fax preauthorization requests as soon as you are aware the member requires services that need to be preauthorized.  Fax to 
• Also fax clinical notes with the request for review.
• If you are directing a member to a noncontracted provider, submit a request for authorization before any service is provided.
• The forms for requesting preauthorization must have all required fields completed, including applicable ICD, CPT, and/or HCPC codes.

Notification of Admission

The admitting facility is responsible to notify Denver Health Medical Plan of an inpatient or observation admission within twenty four (24) hours of admission, unless a weekend or holiday is involved, in which case notification must occur the first business day following the weekend or holiday.

Denver Health Medical Plan covers a wide variety of medications. The Denver Health Medical Plan Formulary Guidelines include information about Denver Health Medical Plan drug coverage. Denver Health Medicaid Choice drug coverage is determined with active participation from an Denver Health Medical Plan physician/pharmacy committee.