Utilization Management

The Utilization Management team manages authorization requests made on behalf of our members. This includes medical, surgical, mental health and addiction medicine requests for inpatient, rehabilitation, DME and other specialty services requiring an authorization for the plan.

Services or items requiring an authorization are identified in the plan documents and can be viewed through the List of Services link below. Authorizations are processed as standard (14 business days) or expedited (72 hours from receipt of request).

Authorization Lists-located on each plan's Member page

• InterCommunity Health Network CCO Authorization List
• InterCommunity Health Network Authorization List 
 
• Samaritan Advantage Authorization List 
• Samaritan Choice Plans Authorization List 
• COHO Authorization List 
• Samaritan Healthy KidsConnect Authorization List

Authorization Forms

• Authorization Form (see the Provider Manual for proper content of a valid request) 
• DME Prior Auth Form
• Imaging Authorization and Referral Form

Case Management Services

Support and assist members who are experiencing immediate and on-going medical conditions or injuries that may require complex, high-intensity, long-term and /or high utilization of services. The team is composed of case management nurses; an exceptional needs care coordinator, a behavioral health coordinator and office support. 
 
Case management services target diagnosis-specific conditions, individuals at-risk, are special needs or members that meet the criteria for health plan quality improvement projects or collaborative initiatives.  Referrals can be submitted through member self referral, health care staff,  physicians, caregiver or  family member,  facility and / or agency working with the member who has the benefit.

• Members and Providers may contact member services to make a referral.
• No specific form is required.
• Members in an eligible plan can agree to opt-out of the program when contacted by the case management department.