Utilization Management

The HAP CareSource MI Health Link Utilization Management (UM) team will review the health care services you get, based on established criteria or guidelines. We review to make sure it is the best care for your needs. The UM department performs activities such as: prior authorization (PA), pre-service review, expedited review, post-service review, discharge planning and other utilization activities. If you have questions about how your care is reviewed, you can contact the UM team through Member Services and the representative will connect you. When calling, please keep the following in mind:

  • UM is open for calls Monday – Friday from 8 a.m. to 8 p.m.
  • You may leave a message about UM issues after normal business hours.
  • You may also use the website to contact UM during and after normal business hours.
  • If you are contacted by UM staff members, they will identify themselves with their names, titles and the organization name (HAP CareSource MI Health Link) when they call about UM issues.
  • Staff are available to accept collect calls regarding UM issues.
  • Staff are accessible to callers who have questions about the UM process.
  • UM is available to conduct utilization review during normal business hours.

You can call us anytime about UM for prior authorization requests. We also give help to members that speak a language other than English so they can talk about UM issues or concerns. Just call Member Services.

Decisions made with your providers about the medical necessity of your health care are based only on how it will affect your care. HAP CareSource MI Health Link does not reward providers or our own staff for turning down coverage or services. We do not offer financial incentives to our staff to urge them to make decisions that result in under-utilization.

New Technology

HAP CareSource MI Health Link depends on research and advances in science to provide their patients with evidence-based, high quality-care. Our New Technology Committee, made up of physicians across HAP CareSource MI Health Link, evaluates medical advances to determine their quality and safety. Participating providers may submit requests for evaluation. By regularly reviewing medical technologies and our benefit coverage, we strive to provide up-to-date, effective and affordable medical care.

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