Authorizations

How to reach our Utilization Management (UM) Department

The UM staff is available 24 hours per day, 7 days per week. You can contact us by phone between 8:00 a.m. and 5:00 p.m. and after hours, weekends/holidays by voicemail or fax. Staff will identify themselves by name, title and organization name when initiating or returning calls regarding UM issues. 

Member Services can connect you to the language line if you need language assistance.

 

What you need to know about our Utilization Management Program

Utilization management is a system for reviewing eligibility for benefits for the care that has been or will be provided to patients. The UM department is composed of:

  • Preauthorization (Prior Authorization)
  • Concurrent review

We update the preauthorization list from time to time. If you are not sure about a certain service or medicine, or if you would like a copy of the most current listing, call Member Services. The lists of medical and behavioral health services requiring preauthorization are also available on this website in your Member Handbook.

Aetna Better Health staff is not paid based on the approval or denial of services. If you have any questions about a utilization management decision, call Member Services or fax your question anytime.

Medicaid Member Services at 1-800-441-5501, 959-888-4124 (fax)

Comprehensive Long Term Care Member Services at 1-844-645-7371, 959-888-4124 (fax)

Florida Healthy Kids Member Services at 1-844-528-5815, 1-877-542-6958 (fax) Monday through Friday 7:30 a.m. to 7:30 p.m. Eastern