Utilization Management/Service Determination

Our Utilization Management/Service Determination (UM) team reviews the health care you get based on a set of guidelines. We review the medically necessary care to make sure it is the best for your needs. You can ask how care is reviewed for procedures including preservice review, urgent concurrent review, post service review, and filing an appeal. CareSource PASSE does not reward providers or our staff for denying services. We do not offer financial incentives to our staff to make decisions that result in under-utilization of services. We want you to get the care you need. We can arrange interpreter services if you or your family’s primary language is not English. We can also help if you have problems with your eyesight, hearing, or have trouble reading.

To learn more about Utilization Management/Service Determination, please refer to your Navigatemember handbook.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. – 5 p.m. CT