Utilization Management

What is Utilization Management?

Vibra Health Plan can assist the member and their provider in understanding the process of determination for clinical requests for procedures and/or admissions based on the specifics of the need

Vibra Health Plan offers Utilization Management (UM) services to support the evaluation of the appropriateness and medical necessity of healthcare service delivery by network providers and facilities. Using nationally accepted evidence-based criteria or clinical guidelines, with an applicable member benefit plan in mind, Vibra Health Plan can assist the member and their provider in understanding the process of determination for clinical requests for procedures and/or admissions based on the specifics of the member’s need. UM services are proactive in supporting pre-certification, concurrent planning, and discharge planning.

National Coverage Determinations

Visit the Centers for Medicare & Medicaid Services’ National Coverage Determinations for a list of items and services covered by Medicare.