Authorizations

How to reach our Utilization Management (UM) Department

The UM staff is available to discuss specific cases or UM questions by phone between 8:00 a.m. and 7:00 p.m. by calling Member Services. Member Services can also connect you to the language line if you need language assistance. UM Staff is available on holidays and weekends by voice mail and fax. The ability to receive faxed information is available 24 hours per day, 7 days per week. Staff will identify themselves by name, title and organization name when initiating or returning calls regarding UM issues. 

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
  • Case management

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)