Review information related to Utilization Management (Prior Authorizations & Predeterminations) - Content now available under Claims and Eligibility menu
Learn more about Prior Authorizations and the Radiology Quality Initiative (RQI) Program through AIM Specialty Health.
Learn more about the Behavioral Health Care Management Program.
Learn more about the eviCore Prior Authorization program.
Have the three character prefix ready to find medical policy, pre-certification and pre-authorization information (for out-of-area members).
Other Clinical Resources Programs
Learn more about clinical practice guidelines.
Our Quality Improvement Department strives to provide products and services of the highest quality and value with a direct focus on meeting the needs of the customer. The process for delivery of care and services is constantly changing offering ongoing opportunities for improvement.
We support our health care provider’s efforts to provide quality services and products and believe that through monitoring and evaluation, we can work together to benefit both members and health care providers. This resource applies to our commercial and retail products and was created as a reference for clinical quality improvement. To assist our providers, we also provide Quality Improvement HEDIS® Tip Sheets and resources for delivering quality care.
Learn more about our Special Beginnings maternity program — a healthy start for mothers and babies.
Review information on providing Telemedicine and Telehealth Services to our members including what’s covered, submitting claims and telehealth vendors.