Utilization Management is a group of services that helps ensure Alliance participants receive the most appropriate care in the most appropriate setting.

Alliance PPO, LLC (Alliance) offers a Utilization Management Program to monitor the quality and the appropriateness of the medical care provided to its participants. Utilization management includes the following:

• Pre-authorization and pre-certification
• Concurrent review
• Discharge planning and case management (large cases)
• Outpatient medical rehabilitation services

These services, as well as when and how you obtain these services, are described below.