Health Benefits

COVID-19 Utilization Review Updates

COVID-19 Utilization Review Updates

Updated 7/20/20

As COVID-19 continues to test the capacity of the healthcare system in certain areas, some states have directed insurers and their utilization review agents, and encouraged third party administrators for their self-funded clients to temporarily suspend utilization management medical necessity reviews to allow providers to focus on treating patients. Since many members are choosing to defer elective procedures at this time, we expect that the temporary suspension of utilization management services will have very little impact on claims during this period.

We’ve gathered the latest updates from states, networks, utilization review vendors, and our preferred stop-loss carriers below. As additional updates are announced, we will share them on this page. Please note, information provided by states, PPO networks, and utilization review vendors may not apply to your Plan. Please refer to your Plan document for applicability.

If you have any questions, please contact your Trustmark sales executive or client manager.

State Announcements

As states announce decisions, we will add/update this list.

Network and Utilization Review Vendor Decisions

Networks and organizations that provide utilization reviews are reviewing states’ requirements and requests. We will share their decisions here as they are announced.

Trustmark Health Benefits’ Preferred Stop-loss Carriers Decisions

As we receive updates from our preferred stop-loss insurance vendors, we will include them here. We also recommend our clients contact their stop-loss insurance carriers directly for more details. The decisions below apply to Trustmark Health Benefits’ clients only.