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Important Information about UniCare's Utilization Management Process

Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member's plan coverage.

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View UniCare's Medical Policies, Clinical UM Guidelines and Clinical Criteria.

You can also request a copy of our UM criteria for a specific condition from our Medical Management department by calling 800-442-9300. Providers may discuss a UM denial decision with a physician reviewer by calling UniCare at 800-442-9300.

Responding to your inquiries

We work with providers to answer questions about the utilization management process and the authorization of care. Here's how the process works:

For language assistance, members can call the Member Services phone number on the back of their ID card free of charge and a representative will assist them.

Our Utilization Management associates identify themselves to all callers by first name, title and our company name when initiating or returning calls. They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you.

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