NC DMA: Local Management Entities (LME) Utilization Management (UM) Proposals

Division of Medical Assistance
Providing access to high quality, medically necessary health care for eligible North Carolina residents through cost effective purchasing of health care services and products.

Local Management Entities (LME) Utilization Management (UM) Proposals

These document are in Adobe Acrobat Reader (PDF) format. The free Adobe Acrobat Reader is required to view and print PDF files.

November 14, 2008 Cover Letter (53 KB)
General Information on Submitting LME UM Proposals (16 KB)
Requirements and Procedures (215 KB)
Requirements Attachments (2.9 MB)
Proposal Evaluation Criteria (10 KB)
LME Response to Utilization Management Readiness Criteria (40 KB)
Rates for Utilization Management/Prior Authorization Reviews (9 KB)
LME Utilization Management Questions and Answers (89 KB)
Information on QIO-like Entities (22 KB)
Guidance on QIO-like Entities (23 KB)
Report on Informal Appeals of Behavioral Health Decisions (14 KB)
Report on Appeals of Behavioral Health Decisions for Services Other than Community Support (12 KB)
Report on Appeals of Behavioral Health Decisions for Community Support Services (9 KB)
Report on Appeals of Behavioral Health Decisions (9 KB)

Updated December 5 , 2008