Utilization Management

We want to make sure members get the right care at the right time… and that this care doesn’t cost them— or their employers—more than it should.

CoreSource offers a utilization management program that reviews medical necessity and appropriate use of healthcare services and facilities for the purpose of determining whether benefits are payable under your health benefit plan. This URAC-accredited program reviews admissions and discharges, outpatient services, and more.

To make sure members are getting appropriate care, program nurses review all certification requests against evidence-based best practices and care-planning tools provided by Milliman. If necessary, the program team utilizes independent physician peer reviews with specialty care providers.