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Utilization Management: Let’s Talk About It

Posted June 8, 2021

A message from Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Illinois (BCBSIL)

Our members, your patients, are top priority at BCBSIL. We’re committed to raising awareness of wellness initiatives, like the importance of preventive health screenings, exercise, nutrition and keeping up with recommended immunizations. We do this through communication campaigns that spotlight online tools and other educational resources our members can use to help themselves and their families take a more active role in matters concerning their health.

The care and services you provide to our members is essential and it’s our goal to provide you with exemplary support. We know you’re busy and we value your time. We understand that navigating administrative operations can be challenging, when you need to focus first on caring for patients. As I’ve mentioned in previous CMO Perspective articles in the Blue Review, based on your feedback, we’ve been evaluating our provider tools and resources to identify areas for improvement.

One area we’re targeting is utilization management. We know prior authorization and related processes can seem complex, so we’re taking steps to help clarify them. You may be familiar with the Utilization Management section of our Provider website. We reorganized this section in late 2020, but we’re continuing to refine and enhance it to help ensure the information is useful.

This month, I’m pleased to announce that we’ve added a new resource to our website. It’s our Utilization Management: Medical Director Video.

  • This interactive tutorial features four short videos on key utilization management topics: Terminology Overview, Intake Process, Peer-to-Peer Process and Appeals.
  • Each topic is narrated by a member of our Medical Director team. You can view one or all of the videos in any order.
  • And there’s a survey you can complete to rate our utilization management resources, provide feedback or ask questions.

With utilization management and other important processes and initiatives, sometimes, it helps to talk it through. I hope you’ll find our new video tutorial interesting and informative.

Learn more about Dr. Derek J. Robinson 

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.