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RightCare Utilization Management

Submitted by sdunn on Fri, 01/03/2014 - 10:10


RightCare Utilization Management

December 6, 2013

RightCare provides access for Members and Practitioners seeking information about the UM process and the authorization of care. UM staff are available during normal business hours at 1-855-691-7947. More information is available at To request a copy of this information, please contact RightCare customer service at 1-855-897-4448.

RightCare is concerned that Members receive appropriate services, and monitors for evidence of under-use, over-use, and misuse. Individual coverage requests are discussed with the individual physicians/providers making the request on behalf of a Member. RightCare UM staff are available by telephone during normal business hours at 1-855-691-7947 for discussions regarding UM and/or coverage determinations, including benefit provisions, guidelines, criteria or the processes used to make determinations.

Any person making decisions on utilization on management, including formulary coverage determinations, makes them based only on the appropriateness of care and services. No financial compensation is based on utilization of services or service denials. RightCare does not offer incentives, including compensations or rewards, to Practitioners or other individuals conducting utilization review.

1206 West Campus Dr.
Temple, TX 76502

RCSWHP 12131