New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 21 - QUALITY MANAGEMENT
Section 8.308.21.17 - UTILIZATION MANAGEMENT
Universal Citation: 8 NM Admin Code 8.308.21.17
Current through Register Vol. 35, No. 18, September 24, 2024
A utilization management (UM) program is an organization-wide, interdisciplinary approach of evaluating the medical necessity, appropriateness, and efficiency of health care services. The MCO shall have an UM program as described in the medicaid managed care agreement services or the managed care policy manual.
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