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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 858-357-2538 Urgent 1 Non-Urgent

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What is mc - rmhp?

mc - rmhp stands for Medicare Creditable Coverage Disclosure for Retiree Prescription Drug Medical Health Plan.

Who is required to file mc - rmhp?

Employers who provide prescription drug coverage to Medicare-eligible individuals are required to file mc - rmhp.

How to fill out mc - rmhp?

Employers can fill out mc - rmhp electronically through the Centers for Medicare & Medicaid Services (CMS) portal or by mailing a paper form.

What is the purpose of mc - rmhp?

The purpose of mc - rmhp is to disclose to Medicare whether the employer's prescription drug coverage is creditable or non-creditable, so that individuals can make informed decisions about their Medicare Part D coverage.

What information must be reported on mc - rmhp?

Employers must report information such as the plan sponsor's name, contact information, plan year, and whether the prescription drug coverage is creditable or non-creditable.

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