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Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American ...
Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [1] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...
Medicaid is healthcare coverage designed to help lower-income individuals in the U.S. pay for basic healthcare needs, like hospital and doctor visits, pregnancy care, and blood tests.
“Behavioral health” is a term for a wide-reaching field that looks at mental health, lifestyle, substance use, patterns of behavior, interpersonal relationships, and more.
UnitedHealth Group Incorporated. UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Selling insurance products under UnitedHealthcare, and health care services and care delivery aided by technology and data under Optum, it is the world's eleventh-largest company by ...
Medicare and Medicaid work together to provide healthcare like the home and community-based services (HCBS) waiver program. Find out what's offered and how to check your eligibility.
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
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related to: united health care medicaid behavioral health prior auth lookup tool