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Network Health

Utilization management

Tufts Health Plan – Network Health established policies and procedures that govern our utilization management (UM) program. We base all UM decisions on appropriateness of care, availability of services, and your patients’ coverage. We do not reward providers, UM clinical staff, or consultants for denying care, and do not offer network providers, UM clinical staff, or consultants money or financial incentives to encourage less use of services. To request our utilization criteria for any of our services or to talk to a clinician about any UM denial decision, please call us at 888-257-1985.

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