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
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