MP CareSolutions is proud to be an NCQA-Accredited Utilization Management services organization.

MP CareSolutions makes decisions regarding the provision of healthcare services based solely on the appropriateness of care and services and the existence of coverage.
MP CareSolutions does not:

  •  Pay any employee, consultant, provider, or independent contractor any financial incentive to deny care
  •  Specifically reward practitioners or other individuals conducting utilization management review for issuing denials of coverage or of care
  •  Provide incentives for utilization management decision-makers that result in underutilization of appropriate services

The right care, at the right place, at the right time.

At MP CareSolutions, our expertise in Utilization Management helps ensure that individuals receive health services that are medically relevant and cost effective.

With our help, you can be confident that the right care is given at the right time, in the right place, by the right provider.

However, in some cases when services are denied, the member and provider have rights to an external appeal.

If a denial was issued because services were deemed not medically necessary, experimental or investigational, or out-of-network, the decision can be appealed to a NYS certified third party external appeal agent. To get an External Appeal application and instructions, call the New York State Department of Financial Services at 1-800-400-8882 or go on line at www.dfs.ny.gov

Proactively identify members for case management

Our clinical review staff is skilled at identifying complex and challenging cases through an interdisciplinary process. This unique feature of Monroe Plan’s Utilization Management services allows health plans to proactively assign case managers to make sure person-centered care plans are developed and cost-effective approaches are utilized.

A comprehensive approach to Utilization Management

With the abundance of medical technology and the explosion of consumer-directed information, health insurers receive many requests for treatment that are of questionable value and may not be medically necessary. Our Utilization Management services team helps guide treatment decisions, while ensuring more people get the care they really need.

Help people get the right care

Our Utilization Management reviews take into account all available information using nationally accepted utilization criteria while recognizing unique individual circumstances. This results in recommendations that are in the best interest of the individual.

Positively address regulatory compliance

Our Clinical Auditing staff makes sure regulatory requirements are met and standardized procedures are utilized to ensure compliance with regulatory oversight agencies.


Let us help you provide the very best care.

We eliminate barriers to good health. It’s the most important thing to your organization—and to ours. Let us help you do it in the most effective way possible. For more information, contact MP CareSolutions at 585-256-8464.