How We Make Decisions About Your Health Benefits

Utilization Management UM is the part of Passport Health Plan and Passport Advantage that makes decisions about your health care benefits. As a member, we want you to know the following about how we make decisions:

• UM decision-making is based only on appropriateness of care and service, and existence of coverage. This means we check to see if a service is medically needed and covered by Passport Health Plan before making decisions.
• We do not reward providers or other individuals conducting utilization review for issuing denials of coverage or services. This means we do not reward anyone, including providers, for denying services to members.
• Financial incentives for UM decision-makers do not encourage decisions that result in underutilization. This means we do not give anyone extra money for making decisions that keep you from getting the care you need.

We want you to get the right care at the right time. If you have any questions about the UM process or decisions, please call Member Services and someone will help you.