Transcription of I. HMO Responsibilities - Health Insurance Illinois
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I. HMO Responsibilities - Health Insurance Illinois
HMO Utilization Management I. HMO A. HMO Program 2. B. Physician 3. C. HMO UM Staff .. 3. D. Program Scope .. 3. E. Program Goals .. 4. F. Clinical Criteria for UM Decisions .. 4. G. Requirements for UM Decision 4. H. New and Existing Medical Technology .. 6. I. Satisfaction with the UM 6. J. Emergency Services .. 6. K. Pharmaceutical Management .. 6. L. Ensuring Appropriate 6. M. Triage and Referral for Behavioral Health Care .. 7. N. Delegation of 7. II. IPA Responsibilities ..9. A. Delegation to the 9. B. IPA UM Plan .. 9. C. IPA Physician and UM Staff .. 10. D. IPA Clinical Criteria For UM Decisions .. 11. E. Access to IPA UM Staff .. 12. F. Requirements for UM Decision-Making .. 13. G. Transition of 18. H. Exhaustion of A Limited 18. I. IPA Denials .. 19. J. IPA Appeal Process .. 20. K. New and Existing Medical Technology.
HMO Utilization Management BCBSIL Provider Manual—Rev 3/09 2 I. HMO Responsibilities A. HMO Program Structure Two health maintenance organizations exist within the managed care structure of Blue Cross and Blue Shield of
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