Life Events

Innovative Care Management Programs

Check out the Innovative Care Management Programs flyer.

Preauthorization/Utilization Management

At Innovative Care Management, our primary concern is that health plan members receive the highest quality care at the most manageable cost. The first step towards this goal is taken in our Preauthorization and Utilization Management program. The medical review process allows us to provide a number of services helpful to the member, such as:

  • Patient Advocacy—In every situation, we want members to receive the treatment they need. We make a strong effort to help members know what questions to ask their doctor, encourage communication between their care providers, and even help coordinate care so that members receive the treatment and medical equipment they need, when they need it.
  • Medical Necessity Determinations—Through our review process, we are able to make certain that expensive procedures and services are the most appropriate treatment for a member to receive, and that there are no better alternatives.
  • Preferred Provider Verification—As a part of the process, we confirm that a preferred provider is being used if possible. Most benefit plans have a preferred
    provider network that could help the member by providing a discounted rate for services and possibly a higher benefit rate if used.
  • Plan Exclusion Identification—Benefit plans have exclusions for certain procedures, and as a part of our review process, we can check benefits and give notification prior to a procedure of any potential problems with coverage.
  • High Risk Screening—While reviewing procedures, we always try to identify members who may have high-risk diagnoses, so that we may refer them to one of our other programs described below.
  • New Technology Research—In cases where new or experimental procedures or technology are requested, we will research information and determine if it is medically appropriate and covered under the benefit plan.

What to Do
When you and your doctor decide that a procedure, treatment, or piece of medical equipment are necessary, just have your doctor call our office to find out about preauthorization. We will then be able to get all of the necessary information to make our determination.

Contact Innovative Care Management or your Human Resources Department to find out more about any of these programs offered to you and your family covered under your health plan.

Toll Free 800.862.3338
Portland Area 503.654.9447
Fax 503.654.8570