UM101 – Criteria for Utilization Review Policy UM-101

The Criteria for Utilization Review Policy UM-101 details the standards and procedures employed by Colorado Access to evaluate the necessity and appropriateness of healthcare services. It encompasses guidelines on what constitutes medically necessary care, applicable to various mental health and substance use treatments. The policy ensures compliance with federal and state regulations by utilizing recognized clinical criteria from trusted sources. Additionally, it fosters informed decision-making in utilization review by employing staff training and inter-rater reliability assessments. The document serves as a definitive guide for all lines of business impacted by Colorado Access’s utilization management practices.