Clover Health Policies

Clover Health Utilization Management Program Description 2020

Policy # UM-001

Prior Authorization Organization Determinations

Policy # UM-003

30 Day Readmission Policy

Policy # UM-004

Peer-to-Peer Review

Policy # UM-010

Denials and Terminations

Policy # UM-013

Single Case Agreements

Policy # UM-016

Reopenings for Organization Determinations

Policy # UM-017
OP Therapy Authorizations- Fifteen visit Policy

Policy # UM-018

IP-PreService Auths not on the CMS IPO List Criteria

Policy # UM-020

Clover Health Administration DME Policy

Policy # UM-021

Clinical Guidelines for inpatient stays

Policy # UM-022

Part C Retrospective Review