Implement Online Utilization Management Portal
Online Utilization Tool Fact Sheet
Pre-Service Review Frequently Asked Questions
Utilization Management User Guide - Inpatient
Utilization Management User Guide - Procedures and DME
Utilization Management - Out of Network
What It Is
- Powered by McKesson’s Clear CoverageTM.
- 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
Utilization Management Tool - Inpatient Resources
Utilization Management Services may be delegated.