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HCBS Utilization Review/Utilization Management

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Purpose of the HCBS UR/UM Program

The Department of Health Care Policy and Financing (HCPF) currently contracts with a vendor, Telligen, to conduct Utilization Review/Utilization Management (UR/UM) reviews. Reviews are conducted to ensure there is no duplication of services and the services requested reflect the identified needs of the waiver participant.

Note: Over Cost Containment (OCC) Reviews no longer apply to PARs effective July 1, 2025.

HCPF requires the HCBS UR/UM review of:  

  • Children’s Extensive Support (CES) waiver eligibility reviews 
  • Participant-Directed Programs Health Maintenance Activities (HMA) UR/UM reviews 
    • Consumer Directed Attendant Support Services (CDASS) for the following waivers: 
      • Brain Injury (BI) waiver
      • Complementary and Integrative Health (CIH) waiver
      • Community Mental Health Supports (CMHS) waiver
      • Elderly, Blind and Disabled (EBD) waiver
      • Supported Living Services (SLS) waiver
    • In-Home Support Services (IHSS) for the following waivers:  
      • Children's Home and Community Based Services (CHCBS) waiver
      • CIH waiver
      • EBD waiver
  • SLS Exception Reviews (effective 1/2/2022) 

Sign up to receive UR/UM and Office of Community Living Communications 

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Telligen Office Hours

The purpose of Office Hours is to provide HCBS Case Managers with UR/UM resources and assistance and will take place once per quarter. 

Meeting Documents

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Training Materials

Getting Started with Telligen's Qualitrac Review and Provider Portal

Using Qualitrac

UR/UM Training 

Information and Tips for UR/UM Reviews

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Forms and Templates

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Memos and Guidance

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Contacts

Sign up to receive UR/UM and Office of Community Living Communications

 

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