Utilization Management (UM)

Our comprehensive utilization management is a systematic approach to addressing your members' behavioral health care needs.

We are fully accredited by Utilization Review Accreditation Committee (URAC). URAC accreditation standards are recognized as providing the benchmarks for quality in managed care organizations. Our comprehensive UM services include:

Prior Authorization and Referral

We are here for your members 24 hours a day, seven days a week. The intake and referral process will provide members with appropriate and individualized care with qualified mental health or substance abuse providers.

Specialty Case Management

Once members begin receiving care, our case management team will coordinate with the provider to assist in meeting the members' needs. All of our specialty case managers are licensed clinicians who are experienced in dealing with mental health and substance abuse issues.

Access to Multi-Disciplinary PPO Networks

BHO provides access to multi-disciplinary provider networks. Facilities and providers are credentialed and re-credentialed every three years according to NCQA standards. We have existing multi-regional networks and are capable of rapid network development.

Concurrent and Retrospective Review

An experienced case manager, under the direction of BHO's Medical Director, is in regular contact with the provider to help ensure the treatment plan meets clinical criteria for the best possible outcomes. This process not only produces consistent excellence in care, but controls costs and provides members with a coordinated plan of health care while creating a collegial relationship with our providers.

Discharge Planning and Continuity of Care

We begin discharge planning at the onset of treatment and it becomes an integral part of the overall treatment plan. Our case managers work hand-in-hand with the treatment providers to deliver individualized treatment plans to the appropriate level of care and clinical services. Regardless of the type of treatment that takes place, an aftercare plan is vital to the success of the patient and the family.

To learn more about our Comprehensive Utilization Management services, please call 1-800-559-9749.