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.
- Promote evidence-based practices.
To reach the Utilization Management department, please click on the the following link.
- Revised ProAuth Demonstration Video June 13, 2023
- Manual Service Authorization Form (to be used only when ProAuth is not active).
- Adult/Child/Physical Health Services Review Forms: Utilization Management (UM) recommends that providers use the Adult, Child, and Physical Health Services Review Information Forms to provide information on the frequency, intensity and duration of current symptoms and behaviors for members in enhanced services. This is a supplemental form to other clinical documentation such as the Comprehensive Clinical Assessment (CCA) and Person-Centered Plan (PCP). This form will aid in the Utilization Management review. Although these forms are available, this information can be provided in other methods of documentation submitted with the Service Authorization Request (SAR). If this information is not submitted, the Utilization Management Reviewer may request that the provider complete the form.
- TBI Funding Guidelines
- TBI Funding Application
- Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
- ASAM Severity Profile Score Sheet
- MH/SUD Authorization Calculator
Updated: June 29, 2023