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Welcome to Eastpointe Medicaid Utilization Review (UR)

Medicaid is a federal and state funded health insurance program for low-income parents, children, seniors and people with disabilities. The N.C. Department of Health and Human Services (DHHS) administers the State’s Medicaid Program through its Division of Medical Assistance (DMA), which is responsible for the daily logistics of delivering services to eligible participants.

Eastpointe's Utilization Managment (UM) Process is on the the necessary key functions in managing Eastpointe's Prepaid In-patient Health Plan (PIHP) resources. Eastpointe maintains a comprehensive and effective UM Plan/Program to review proposed care in order to evaluate the medical necessity, efficacy, frequency, duration and setting of the services based on a set of clincial decision support tools, level of care criteria and clincial outcomes. Eastpointe reviews the medical necessity and appropriateness of care in a fair, impartial and consistent manner.

Items Needed for Authorization

Webinars:
**Note: Due to the size of these videos it is recommended that you download them prior to viewing by Right clicking the link and using the Save Target As option. The video playback will be much smoother if you utilize this method.
URAC Seal HN URAC Seal HUM URAC Seal HCC