Utilization Management (UM) Overview Partners Health Management’s Utilization Management (UM) department ensures equitable access to high-quality, medically necessary services across our service area. How UM Decisions Are Made Partners does not offer incentives to UM staff or providers to deny, reduce, limit or discontinue services. There are no financial rewards that discourage approval of medically

Referrals to Specialty Treatment Partners’ Utilization Management (UM) has separate referral processes for the following services: Alcohol and Drug Abuse Treatment Centers (ADATC) Electroconvulsive therapy (ECT) NC Innovations Level of Care NC Innovations Medical Assessment Alcohol and Drug Abuse Treatment Centers (ADATC) Providers must follow the ADATC referral procedure and submit required forms by fax.

Service Authorization Requests (SAR) Overview Partners’ Utilization Management (UM) team reviews initial, continuing care and retrospective requests to determine medical necessity. UM decisions are guided by North Carolina Division of Health Benefits (DHB) Clinical Coverage Policies and Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSUS) State-Funded Service Definitions. A Service Authorization Request