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Important Information about UniCareís Utilization Management Process

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

Notice regarding financial incentives

View UniCareís medical policies and UM guidelines.

You can also request a copy of our UM criteria for a specific condition from our Medical Management department. 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. Hereís how the process works:

For language assistance, members can call the Member Services phone number on the back of their ID card 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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For self-funded plans, claims are administered by UniCare Life & Health Insurance Company. © 2018 UniCare