Acute Hospital Utilization Management Program

On behalf of the Executive Office of Health and Human Services, the University of Massachusetts Medical School (Office of Clinical Affairs) contracted with Permedion to perform utilization management services rendered to MassHealth members by acute hospital providers.

Permedion is conducting Preadmission Screening (PAS) Reviews for all elective inpatient hospital admissions. In addition, Permedion performs prepayment (inpatient) review and postpayment retrospective review of selected hospital claims. The New MMIS system is the application used to conduct Preadmission Screening Reviews.

Preadmission Screening operations began with implementation of a fully-staffed call center on November 2, 2009. Prepayment review of services also started the first week in November and both inpatient and outpatient postpayment review began January 31, 2010.

The contract requires a fully-implemented Provider Relations Program, which involves regular meetings and onsite visits with Massachusetts acute care hospital providers by a full-time Provider Relations Manager. The purpose of this program is to educate the providers regarding the review process and to communicate trends and common errors.

Permedion will publish newsletters designed to offer education to the hospital providers regarding the utilization review process.

Click below to download or view:

• PAS Form – December 21, 2010
• Time Frame for Postpayment Medical Record Requests Extended to 30 Days
• Massachusetts Hospital Association Member Presentation – May 26, 2010
• Massachusetts Hospital Association Member Presentation – October 27, 2009
• Provider Questions and Answers – October 27, 2009 Presentation
• Change of Contact Form

Contact Information

Questions or inquiries regarding the Utilization Management Program for MassHealth can be sent to MAUR@hms.com.