Utilization Management

CHM has an effective and comprehensive utilization management program designed for the correctional environment. We follow Milliman Care Guidelines® as screening criteria to review the medical necessity of offsite appointments and length of stay for inpatient hospitalizations. Our program enhances inmate care by ensuring that care is provided in a timely manner when medically needed. Providing care in a timely manner has the benefit of slowing the progression of disease or worsening of symptoms, which can result in a reduction in costs. Additionally, managing and providing treatment in a consistent manner improves the quality of care.

CHM’s program is comprised of four key interactive components – prospective review, concurrent review, readmission review and retrospective review. The complete review occurs prior to the delivery of elective care such as scheduled hospitalizations, outpatient surgical procedures, specialty office visits, etc. It is designed to ensure the delivery of the most appropriate care, at the right time, in the most cost-effective setting.