Common use of Benefits Management Program Clause in Contracts

Benefits Management Program. The Benefits Management Program applies uti- lization management and case management princi- ples to assist Members and providers in identify- ing 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 various medical benefits, including inpatient admissions, outpa- tient services, and prescription Drugs administered in the office, infusion center or provided by a home infusion agency, as well as emergency admission notification, and inpatient utilization management. The program also includes Member services such as, discharge planning, case management and, pal- liative care services. The following sections outline the requirements of the Benefits Management Program.

Benefits Management Program. The Benefits Management Program applies uti- lization management and case management princi- ples to assist Members and providers in identify- ing 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 various medical benefitsinpatient admis- sions, including selected inpatient admissions, outpa- tient and outpatient services, office-administered injectable drugs, and prescription Drugs home-in- fusion-administered in the office, infusion center or provided by a home infusion agencydrugs, as well as emergency admission notification, and inpatient utilization management. The program also includes Member services such as, discharge planning, case management manage- ment and, pal- liative palliative care services. The following sections outline the requirements of the Benefits Management Program.