Coverage Information

Claims Payment Policies & Other Information: Retroactive denials

Some claims may be retroactively denied, even after the member has obtained services from the provider. A retroactive denial is the reversal of a previously paid claim, through which the member then becomes responsible for payment.

There are ways to prevent this from occurring. You can:

  • Notify promptly of changes that could impact your eligibility or your premium amount owed.

  • Submit requested documentation to and/or (issuer name) promptly or within time constraints.

  • Pay your monthly premiums on time


Members may obtain a refund of premium overpayment by notifying of changes that could impact eligibility or your premium amount owed and then contacting  Customer Service at 855-447-2900. Please note that in some situations, changes to eligibility must be received from before MHC can refund an overpayment.

Informative Documents

Member Forms

Click on buttons below to download the forms you need.

Prescription Claim Form

A form to request reimbursement for out of pocket payment of prescription drugs

Mail Order Prescription Form

Medical Claim Form

Special Enrollment Period Validation List

Member-Designated Representative Form

Monthly Premium Withdrawal Form

Change Form


Information on your appeal rights.

Click to go to an online form to file an appeal.

Anti-Discrimination Policy

Incapacitation Review 

Direct Application - ID

Direct Application - MT

Direct application only, NOT marketplace applications


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Mountain Health CO-OP does not discriminate based on race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.


Contact Us with Questions About Coverage