Utilization Management

Making sure care is necessary, to prevent overpaying.

At EHBA we provide Utilization Management, a review of the medical necessity, appropriateness and efficiency of healthcare services used under the provisions of the health benefits plan.

Our Utilization Management professionals work with members before they receive care and while they receive care, to ensure the most appropriate treatments are given. Our nurses, supported by a full panel of physician specialists, review all inpatient and outpatient services received to:

• Ensure doctors' orders are carried out in an efficient and accurate manner.
• Identify questionable medications or procedures.
• Plan ahead and monitor the member's progress.

By working closely with healthcare providers, we give members information and options that can reduce hospital stays and speed recovery.