Utilization Management
Utilization Management (UM) reviews the health care you get based on guidelines. We review care to make sure it is the best for your needs. You can ask how care is reviewed for procedures. This review can be: preservice, urgent concurrent, post service, or filing an appeal. CareSource does not reward providers or our staff for denying services. We want you to get the care you need. We can arrange interpreter services in your preferred language. This is at no charge to you. We can also help with audio or explain topics more.
Questions for UM?
Call 1-855-202-1058 (TTY: 711) and ask for the UM team. We are open Monday through Friday, 8 a.m. to 5 p.m.
- You can leave a message after normal business hours.
- Fill out the Tell Us Form You will get an answer the next business day. UM staff will say their name and title and that they are from CareSource.
New Care Approvals
CareSource may decide a new development not covered by Medicaid will become covered. This can be newly developed:
- Health care services
- Medical devices
- Therapies
- Treatment options
Coverage is based on:
- Updated Medicaid rules
- External technology assessment guidelines
- Food and Drug Administration (FDA) approval
- Medical literature recommendations
Member Services: 1-855-202-0729 (TTY: 711), Monday through Friday 7 a.m. – 7 p.m.