Utilization Management
In keeping with DFS guidance, MetroPlusHealth’s UM protocols will resume on June 22, 2020.
last updated: July 17, 2022
On June 22, 2020, MetroPlusHealth will resume issuing Prior Approvals and performing concurrent review. A grace period will be provided for hospital services that have been scheduled during the week of June 22, 2020 since hospitals were unable to obtain Prior Approval. As a result, MetroPlusHealth will not deny claims for hospital services provided on or after June 18th through July 6th solely due to lack of Prior Approval.
MetroPlusHealth will resume retrospective reviews for medical necessity beginning June 22, 2020. MetroPlusHealth shall follow DFS guidance with regard to retrospective reviews.
For information regarding MetroPlusHealth’s Utilization Management guidelines, please see here.
Talk To Us About Questions Or Concerns
Monday–Saturday | 8 a.m.–8 p.m. (ET)
Sunday | 9 a.m. –5 p.m. (ET)
Talk To Us About Any Questions or Concerns
Monday–Saturday | 8 a.m.–6 p.m. (ET)
Sunday | 9 a.m. –5 p.m. (ET)
Topic: MetroPlusHealth Annual Public Meeting
Date/Time: Tuesday, December 13th @ 4:00PM
Zoom Webinar Information Below
Please click the link below to join the webinar:
https://metroplus-org.zoom.us/j/85027965324?pwd=bDRBTnFjeW1JZUxLQ2pHU1NZY0pnQT09
Passcode: 498808
Or One tap mobile :
Or Telephone:
Dial (for higher quality, dial a number based on your current location):
+1 646 558 8656 or +1 301 715 8592 or +1 312 626 6799 or +1 253 215 8782 or +1 346 248 7799 or 1 669 900 9128
Webinar ID: 850 2796 5324
International numbers available: https://metroplus-org.zoom.us/u/kbBFHldTq
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