Utilization Management - Chapter Table of Contents
Published: October, 2001
Utilization Management Program
PacifiCare Behavioral Health monitors and evaluates all aspects of the behavioral health care delivered by its network providers...more
Utilization Management Activities
The PBH UM Committee reviews and analyzes utilization data for individual, group and facility providers and for all levels of care and across all lines of business...more
Financial Incentives for UM Decision-Making
PacifiCare Behavioral Health, Inc. (PBH) makes utilization management decisions based solely upon the appropriateness of the care and service for its members...more
Provider Dispute Resolution Process
For Western, Northwestern and Southwest (Colorado Only) Regions.
PBH provides a process for providers to appeal claims payment and treatment authorization determinations made by PBH...more
Provider Dispute Resolution Process
For Southwest Region (Texas and Oklahoma Only).
In Texas and Oklahoma, the provider appeal process is not delegated to PacifiCare Behavioral Health...more
Clinical Reviewer Available to Discuss Denials
PBH makes available to practitioners an appropriate reviewer...more
New Technology Assessment
PacifiCare Behavioral Health identifies and evaluates proposed advancements in behavioral health treatment in order to ensure that PBH members receive the highest quality care to meet their individual need...more
