Utilization Management
Our Utilization Management (UM) team reviews the health care you get based on a set of guidelines. They go over this care to make sure it is the best for your needs. You can ask how care is reviewed. You can ask about:
- Preservice review
- Urgent concurrent review
- Post service review
- Filing an appeal
We do not reward providers or our staff for denying services. We want you to get the care you need. We can get you an interpreter 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. Call Member Services and ask for the UM team if you have questions. Please keep in mind:
- We are open for calls Monday through Friday from 8 a.m. to 5 p.m. You can leave a message about UM issues after these hours.
- Reach UM using the Tell Us form.
- UM staff who call you will say their name and title and that they are from CareSource.
Learn more about Utilization Management in your member handbook.
Questions? Call Member Services at 1-800-488-0134 (TTY: 711). We are open Monday through Friday, 7 a.m. to 8 p.m.