Common use of Benefits Management Program Clause in Contracts

Benefits Management Program. The Benefits Management Program applies utilization management and case management principles to assist Members and providers in identifying the most appropriate and cost- effective way to use the Benefits provided under this health plan. The Benefits Management Program includes prior authorization requirements for inpatient admissions, selected inpatient and outpatient services, office-administered injectable drugs, and home-infusion-administered drugs, as well as emergency admission notification, and inpatient utilization management. The program also includes Member services such as, discharge planning, case management and, palliative care services. The “Prior Authorization List” is a list of medical services and drugs that require prior authorization. Members are encouraged to work with their providers to obtain prior authorization. Members and providers may call Customer Service at the number provided on the back page of this Evidence of Coverage to inquire about the need for prior authorization. Providers may also access the Prior Authorization List on the provider website. The following sections outline the Member’s responsibilities under the Benefits Management Program. The Benefits Management Program applies to all Members.