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 call 1-877-864-1454.
- Manual Service Authorization Form (to be used only when Alpha+ is not active)
- Adult/Child Services Review Forms: Utilization Management (UM) recommends that providers use the Adult and/or Child Services Review Information Form 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 Comprehensive Clinician Assessment (CCA) and Person-Centered Plan. This form will aid in the Utilization Management review. Although this form is 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
How to Submit a Service Authorization Request (SAR):