KanCare Training for Providers - Ubhonline.com

Eligibility and Benefit Review Process
• When a request for services is received, Optum will:
– review member benefit eligibility
– gather required clinical information
– reference the appropriate criteria set
– determine whether the requested care meets medical
necessity criteria
• Optum may certify levels of care and treatment services that are
specified as available under the specific benefit plan (e.g., acute
inpatient, residential, partial hospitalization, intensive outpatient, or
outpatient)
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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