Products & Services: Behavioral Care Management:
Utilization Management

HBI has an extensive utilization review and pre-certification program encompassing both inpatient and outpatient services.  The goal of utilization management is to ensure that every plan member receives quality care in the most appropriate, safe, efficient, and cost-effective setting.

Utilization Management Components

Preauthorization Review
An initial evaluation is conducted by HBI professionals specializing in the mental health field.  Through preauthorizing admissions and closely monitoring treatment, a comprehensive assessment of each participant will be attained in the areas of chemical dependency and psychiatric conditions.  HBI professionals are responsible for authorizing such admissions for acute hospital, subacute inpatient, day treatment, and intensive and regular outpatient programs, 24 hour a day, 7 a week.

Concurrent Review
HBI ensures effective interface and communication among the eligible member, provider, treatment facility, and utilization review mechanism.  Through consultation with the treating facility and the appropriate physicians, HBI will review course and setting of treatment, medical necessity, procedures, and length of stay for appropriateness of care.

Retrospective Review
HBI assesses the medical necessity of treatment prior to payment of any hospital or outpatient related claims where preadmission or continued stay review did not occur.