Utilization Management
Ensuring the right service is provided at the right time in the right amount.
MDHHS / PIHP Service Authorization Denials Reporting
Region 10 PIHP recently received a new MDHHS reporting requirement in the area of Service Authorization Denials. The mandatory template, MDHHS_PIHP Service Authorization Denials Reporting Template, requires the PIHP and CMH providers to provide documentation of all Denied Service Authorizations. You will find the report template below.
MDHHS / PIHP Service Authorization Denials Reporting Template
Utilization Management (UM)
Posted below are links to essential documents in connection to the Region 10 PIHP UM Redesign.
Region 10 UM Service Grid
The first essential document is the current version (published 6/23/21) of the Region 10 UM Service Grid. Arranged by service population and including all available specialty services, the service grid identifies “typical” service utilization as developed within the person-centered planning process. Based on ongoing data analysis of service utilization and aligned with the R10 Clinical Practice Guidelines, the service grid will be published periodically to reflect as-needed updates.
UM Redesign Pilot Project Kiosk - Questions and Answers
With the assistance of your CMHSP representatives participating on the UM Redesign Pilot Project Implementation Work Group, this web page will help keep you informed about Pilot activities as well as keep you up-to-date as we move forward with other planned redesign and implementation activities.
October 23, 2019 Pilot Project Kiosk - Questions and Answers
September 5, 2019 Pilot Project Kiosk - Questions and Answers
July 26, 2019 Pilot Project Kiosk - Questions and Answers
June 10, 2019 Pilot Project Kiosk - Questions and Answers
May 28, 2019 Pilot Project Kiosk - Questions and Answers
Additional Resources
Posted below are other essential training and webinar documents for your reference.
Utilization Management (UM): A Primer