Utilization Management

Utilization Management Program Description

Related Policies and Procedures

Emergency Services: Retrospective Authorization

Independent Medical Review

Medical Policy Development Application

Out of Area Dialysis Services

Outpatient Observation versus Inpatient and Midnight Rule

Second Opinions

Standing Referrals to Specialists

Treatment Authorization Request: Authorization Process and Timeline Standards

Utilization Management Policy For Appeals

Medication-Related Policies

• Coverage of Prescription Medication for Off-Label Use
• Pain Management for Terminally Ill Patients
• Prior Authorization of Medications

Health Services Approval Process

Authorizations and Referrals (NEW)

Diagnostic Studies requiring Prior Authorization

Direct Specialty Referral Form

Direct Specialty Referral Policy

Language Attestation Form

Pre-Authorization Treatment Authorization Form

Retro Treatment Authorization Form

Prescription Drug Prior Authorization Request Form – Effective 12/2016

Prescription Drug Prior Authorization Request Form Legislation

Services Requiring Prior Authorization

Provider Dispute Resolution Request Form

Provider Update Request Form

VCHCP’s Referrals and Prior Authorization Process