PacifiCare Behavioral Health monitors and evaluates all aspects
of the behavioral health care delivered by its network providers.
The PBH Utilization Management Program is designed to ensure
that members receive access to timely, appropriate and affordable
quality mental health care and services. The PBH UM Program
is one component of the comprehensive PBH Quality Improvement
Program. Key aspects of service addressed in the UM Program
are Medical Necessity, appropriateness, availability, and
accessibility. Since all PBH services are offered in the context
of a defined benefit plan, an additional but critical aspect
of service addressed by the PBH UM Program is the efficiency
of services to members. PBH's Utilization Management Committee
is charged with annual review and implementation of the UM
Program, regular review of UM data, and implementation of
corrective actions whenever indicated.
