Meet the Utilization Management Team
What do you know about the Utilization Management (UM) Department at Aspire? Did you know the UM Department is part of our Quality Team and provides administrative support services focused on promoting quality assurance? The UM team reviews service utilization data for Aspire service locations and obtains prior authorizations (PAs) for services our clients are entitled to. This includes in- or out-of-office therapy, group therapy, skills training, case management, Behavioral and Primary Healthcare Coordination Program (BPHC) and addiction services.
Most insurance providers require some form of PA before services are rendered. UM seeks to ensure all PAs are tenable and that all policies, procedures and regulations are followed so Aspire can be reimbursed for services. UM is a source of contact and expertise for a variety of insurance providers, including Medicaid, Healthy Indiana Plan (HIP), Medicare and Medicare Advantage Plans as well as commercial insurances. The team works in coordination with treatment providers to complete PA requests and ensure medical necessity is being met.
The UM Department is happy to assist Aspire staff with any questions or concerns related to requesting more units, Medicaid Rehabilitation Option (MRO), Child and Adult Needs and Strengths Assessment (C/ANSA), Level of Need (LON), service packs, Substance Use Disorder (SUD) PAs, Current Procedural Terminology (CPT) codes and medical necessity.
Say hello to the UM team:
Rob Bruce — Utilization Management Manager
Mary McKinney — Specializes in Substance Use Disorder (SUD) PAs for Mockingbird Hill (MBH), monitoring commercial insurance for needed authorizations on a client’s intake and ongoing services.
Jennifer Caswell — Specializes in SUD PAs for MBH, monitoring for exhausting Indiana Department of Child Services (DCS) and Child Mental Health Initiative (CMHI) authorizations as well as Child and Adult Needs and Strengths Assessment (C/ANSA) update/discharge needs.
Pepper Moore — Specializes in PA needs for Medicaid Clinic authorizations, MRO special requests for more units, BPHC expired units and Medicaid/Medicare dual coverage services.
Serena Hendershot — Specializes in authorization needs for MHS and CareSource Medicaid clients, monitoring daily Medicaid intakes to ensure appropriate authorization counts are in place, and addressing MRO denials.
Chris Gray — Specializes in changes to MRO from insurance changes, errors in C/ANSA processing and appropriate LON reflection on service packs.
Judy Zelinsky — Specializes in UM’s record keeping, vocational rehab (VR) auths and all handling of PA responses from insurance.
Any questions? Please don’t hesitate to reach out to the UM team! Contact them at u
