Utilization Management

Utilization Management is the evaluation of the medical necessity, appropriateness, and efficiency of use of health care services, procedures, and facilities. It includes a variety of strategies designed to ensure patients receive the right service by the right provider, at the right time, at the right level of care.

Below, you’ll find an overview of Utilization Management programs for 2021 and 2022.

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2021 Resources

  1. Log in to
  2. Click Patient Registration | Authorization & Referrals in the top left of the screen
  3. The Authorization & Referrals page displays
  4. Click Auth/Referral Inquiry or Authorizations to begin an electronic authorization request

For detailed step-by-step instructions on submitting authorizations electronically, please review the user guide on under payer spaces.

Commercial Plans Prior Authorization List - Florida Markets

Commercial Plans Prior Authorization List - NON-Florida Markets

The authorization change request form can be used when Providers need to change any of the following items on an existing authorization.

  1. Servicing Provider or Facility Name

  2. Dates of Service for a planned procedure

  3. The number of days/units/visits needed for a specific service

Use this form when you need to change information on a pending or approved authorization. Note that the form is not intended to add codes to an authorization. For an approval of additional services, please submit a new authorization request.

Case Management Bright HealthCare case management referrals can be submitted via phone or fax using the Case Management Referral Form. IFP Request via phone: 1-888-658-6818 MA Request via phone: 1-888-668-0804 Submit via fax: 1-833-903-1607

Colorado

Per prior authorization bill HB19-1211 or C.R.S. § 10-16-112.5, the state of Colorado requires carriers and organizations to publish prior authorization data.

For 2022 Services Dates, please select the member’s state below

Individual and Family Plans

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Form

IFP Provider Services Phone Number: 866-239-7191

Individual and Family Plans (IFP) or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via the .

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Inpatient Form

Behavioral Health Outpatient Form

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

 

 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans (IFP)

Authorization Resources

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

 

Forms

Authorization Fax Form

IFP Provider Services Phone Number: 844-926-4525

 

Medicare Advantage

MA Provider Services Phone Number: 844-926-4522

Individual and Family Plans (IFP) or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via the .

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Inpatient Form

Behavioral Health Outpatient Form

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

 

 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

 

Bright HealthCare Data Regarding Approvals and Denials of Prior Authorization Requests

Colorado

Per prior authorization bill HB19-1211 or C.R.S. § 10-16-112.5, the state of Colorado requires carriers and organizations to publish prior authorization data.

Individual and Family Plans (IFP)

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via the .

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Inpatient Form

Behavioral Health Outpatient Form

IFP Provider Services Phone Number: 866-239-7191

 

 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans (IFP)

Forms & Resources

Authorization Fax Form

IFP Provider Services Phone Number: 844-926-4525

Individual and Family Plans (IFP)

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via the .

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Inpatient Form

Behavioral Health Outpatient Form

IFP Provider Services Phone Number: 866-239-7191

 

 

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Form

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

Medicare Advantage

Authorization Resources

2022 Resources - Utilization Management Changes

 

Forms

Submit an authorization to Bright HealthCare for all MA services (except for Acupuncture and Chiropractic services) by faxing the below form to 1-888-337-2174.

MA Authorization Fax Form – All services EXCEPT Acupuncture and Chiropractic.

MA Patient Referral Form – All services EXCEPT Acupuncture and Chiropractic.

MA Fax Number: 1-888-337-2174

MA Provider Services Phone Number: 1-844-926-4522

Submit an authorization to American Specialty Health (ASH) for Acupuncture and Chiropractic services by going to and using their online portal or fax forms.

For questions about an authorization or to change an authorization, contact ASH Provider Services at (800) 972-4226.

American Specialty Health Contact Information:

Provider Services phone number: (800) 972-4226 | Fax Number: (877) 304-2746

Individual and Family Plans or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Form

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

Individual and Family Plans (IFP)

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via the .

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 Redesigned Authorization Portal Resources

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Inpatient Form

Behavioral Health Outpatient Form

IFP Provider Services Phone Number: 866-239-7191

Individual and Family Plans

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Form

IFP Provider Services Phone Number: 866-239-7191

Individual and Family Plans or Small Group

Authorization Resources

To submit authorizations for all services except diagnostic/advanced imaging, radiation oncology, and genetic testing, please use the below fax forms or submit electronically via

To submit authorizations for diagnostic/advanced imaging, radiation oncology, and genetic testing, please visit , or call AIM at (833) 305-1802, Monday-Friday 7am-7pm CT, excluding holidays.

2022 AIM Resources – Radiology, Radiation Oncology, Genetic Testing

2022 AIM Codes – Genetic Testing

2022 AIM Codes - Radiation Oncology

2022 AIM Codes - Radiology

 

Forms & Resources

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Form

IFP Provider Services Phone Number: 866-239-7191

Small Group Provider Services Phone Number: 855-521-9364

Individual and Family Plans (IFP)

Forms & Resources

Authorization Fax Form

IFP Provider Services Phone Number: 844-926-4525

Individual and Family Plans (IFP)

Forms & Resources

Authorization Fax Form

IFP Provider Services Phone Number: 844-926-4525

Individual and Family Plans (IFP)

Forms & Resources

Authorization Fax Form

IFP Provider Services Phone Number: 844-926-4525