UTILIZATION MANAGEMENT

CareAccess MSO processes all requests for authorizations for our contracted managed care IPA networks. Our experienced Medical Directors, nurses, and case management follow the patient through the healthcare system with continuous reviews over inpatient and outpatient services. We ensure that the utilized facilities and resources are appropriate as well as providing quality care.

 

Our UM committee consists of board-certified physicians in a variety of specialties, allowing members to receive the most appropriate medical care. Through our comprehensive utilization management and review processes, we provide the appropriate effective care for all members and save our managed groups from unnecessary medical costs. The UM/Case Management decision-making criteria, UM Program, policies and procedures are available to practitioners, members and the public upon request.

AFFIRMATIVE STATEMENT

1) UM decision making is based only on appropriateness of care and service and existence of coverage​

2) The organization does not specifically reward practitioners or other individuals for issuing denials of coverage​

3) Financial incentives for UM decision makers do not encourage decisions that result in underutilization

©2020 CareAccess MSO, Inc. All Rights Reserved.

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