Utilization and Review

The Utilization Review Department is responsible for the process of monitoring the use, delivery, and cost-effectiveness of services for eligible Medicaid members’ transportation requests to Medicaid billable services, as directed by the Department of Community Health (DCH)- Policies and Procedure Manual for Non-Emergency Brokers Services.

Utilization Review incorporates in its process the role of member advocate, by reviewing and offering reconsideration of transport requests, outside of the geographical standards (mileage guidelines), based on the confines of the DCH Policies and Procedures Manual for Non-Emergency Broker Services.

Medicaid members are within the following general geographic access standards for health care services:

  • 30 miles Urban
  • 50 miles Rural
  • 15 miles Adult Day Health Care Urban and 30 miles Rural
  • 15 miles Pharmacies Urban and 30 miles Rural