Utilization Management (UM)

Utilization Management is the evaluation and determination of the appropriate use of medical-care resources and the providing of any needed assistance to the member, physician or other provider.

The UM process ensures appropriate use of resources through the health care system. This may include prior authorization of a product or service, concurrent review while you are an inpatient in any health care facility for which benefits are covered, and discharge planning.

Decisions are made based on whether or not a service is medically necessary and covered under your plan. Refer to your plan documents for information about what services are covered under your plan.

AultCare provides you with access to staff to discuss the UM process and any issue relating to the UM process. Professional staff members are available from 8 a.m. to 5 p.m. Monday-Friday by contacting the AultCare Service Center at 330-363-6360 or toll free at 1-800-344-8858. The TTY number for the hearing impaired is 330-363-2393 or toll-free at 1-866-633-4752. If you call after business hours, please leave a message and we will respond to your call the next business day.