• Online Utilization Tool Fact Sheet 
• What It Is 
• How It Works 
• Utilization Management Tool – Procedures & DME Resources 
• Utilization Management Tool – Inpatient Resources 

Online Utilization Tool Fact Sheet

 
^{Download PDF of Fact Sheet} 

Pre-Service Review Frequently Asked Questions 

Utilization Management User Guide - Inpatient 

Utilization Management User Guide - Procedures and DME 

What It Is

• Powered by McKesson’s Clear Coverage^TM.
• Used for submitting authorization requests.
• Implemented in three phases.

How It Works

• Because the tool is interactive and uses real-time data, instant approval can occur when medical necessity criteria is met.
• Users will follow a three-minute, seven-step process to request an authorization.
• When approval is given, an authorization number will be generated.
• The authorization number will need to be put on the claim when it is submitted.
• Prior approvals are required.
• If authorization is not completed for a service, procedure, or DME that requires pre-service review, the claim will be denied. 

Utilization Management Tool - Procedures & DME Resources

• Prior Approval Resources  
• Steps to Complete a Prior Approval 
• Steps to Address Out-of-Network 
• Authorization Table Start Here Flyer 

Utilization Management Tool - Inpatient Resources

• Notification Requirement Resources 
• Steps to Complete a Hospital Admission Notification 
• Steps to Complete a Hospital Discharge Notification 
• Authorization Table Start Here Flyer