Utilization Management Policies
Learn more about LifeSynch policies for discussing utilization management denial decisions and decisions about appropriateness of care.
Discussing Utilization Management Denial Decisions
LifeSynch provides practitioners with the opportunity to discuss any utilization management denial decision based on medical necessity or clinical appropriateness with a licensed, board certified psychiatrist or another appropriate doctoral-level behavioral health reviewer.
To schedule a discussion with a reviewer, please contact the LifeSynch telephone number on the back of the enrollee’s insurance card. You may also call our help line at 1-800-777-6330. A customer service representative will connect you to a case manager who will schedule the discussion.
Affirmative Statement Regarding Incentives
LifeSynch certification decisions are based only on the appropriateness of care and service, as well as the existence of coverage.
LifeSynch does not reward physician reviewers, case managers, employees, practitioners, or other individuals for issuing denials of coverage or service.
LifeSynch does not pay incentives to physician reviewers, employees, practitioners, or Other individuals to reduce the provision of care which is deemed medically necessary.
LifeSynch does not give financial incentives to physician reviewers, case managers, employees, practitioners, or other individuals to encourage decisions that result in underutilization of care or services.
