The Utilization Management (UM) Department ensures that individuals have equitable access to appropriate care across the Partners catchment area.

Partners does not offer incentives to Utilization Management employees or providers to deny (reduce, terminate or suspend), limit, or discontinue medically necessary services to any member. There are no financial rewards for Utilization Management decision makers that would discourage approval of services. Decisions made by Partners’ Utilization Management are based only on the appropriateness of care, the service requested, and existence of coverage.

UM ensures quality services through compliance with clinical guidelines. This “compliance” results in individuals receiving services that:

  • Support recovery
  • Reflect enrollee preferences
  • Are efficient and cost effective
  • Occur in the most appropriate and least restrictive setting
  • Are consistent with medical necessity criteria and
  • Promote evidence-based practices.

To reach the Utilization Management Department, please call 1-877-864-1454.