Utilization Management Program

The Priority Health Utilization Management (UM) program supports the health care delivery services provided by physicians, hospitals, behavioral health practitioners, home care agencies, PHOs/POs and others as appropriate. 

Patients covered
This program applies to all dimensions of health care delivered for commercial as well as Medicaid and Medicare members of Priority Health and Priority Health Government Programs, Inc., respectively, through relationships established with employer groups and the State of Michigan.

Program components
The UM program includes prior authorization, utilization review, transitional care planning, retrospective review and case and disease management. Members and providers can speak to staff members regarding the UM process or decisions.  Information regarding how to contact the staff members is included in newsletters and here in the Provider Manual.

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