Implement Online Utilization Management Portal

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 

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.

 
 
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