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Utilization Management

We want your patients to get the most out of their healthcare plans. Which is why we created our utilization management program. It's designed to ensure high-quality and cost-efficient health care for all members.

And to make sure this goal is always a top priority, our program is updated, reviewed and approved annually by the Medical Advisory Council. You can access the utilization management program online or by contacting the  Utilization/Case Management Department at 419-887-2520 or 1-800-891-2520.

Please review the appropriate fax numbers for each request type.

As you might expect, program requirements may vary based on a member's specific benefits, but the following are helpful overviews for various topics:

Case Management

Emergency Room Services

Inpatient Hospitalization

Out-of-Plan Referrals

Outpatient Certification

Paramount Advantage Dental Prior Authorization 

Respite Care (Advantage)

Retrospective Review

Specialist Referrals

Tertiary Care Services