Clinical Resources

Clinical Practice Guidelines

Preventive Health Guidelines

Utilization Management

Utilization Management requests are initiated by providers by either phone or faxing the applicable form below to the intake department:

Utilization Management Contact Information

  • Medicaid (STAR) and CHIP Intake phone number: 1-877-560-8055
  • STAR Kids intake phone number: 1-877-784-6802
  • Intake fax number: 1-855-653-8129
  • Intake fax number for concurrent review (inpatient requests): 1-855-653-8129

Concurrent stay Requests are initiated when a member is currently in the hospital bed and reviewed within 24 hours.

Prior authorization requests are initiated before outpatient services have been provided and are reviewed as follows:

  • Routine request: within three business days
  • Urgent request*: within 72 hours

Please have the following information available when calling the intake department at 877-560-8055:

  • Member name and identification number
  • Diagnosis code(s)
  • Procedure code(s)
  • Date of service
  • Primary care physician, specialist and facility names
  • Clinical justification for request
  • Treatment and discharge plans (if known)

Services requiring prior authorization PDF Document


* Urgent Prior Authorization is defined as a condition that a delay in service could result in harm to a member.