UM Policy

Vaya’s Utilization Management (UM) Program helps us make good decisions about your health care and spend our limited taxpayer dollars responsibly, in line with NCDHHS requirements. Our UM clinicians evaluate the medical necessity of requested services and help ensure services are appropriate and effective. 

Vaya’s UM Policy and Program Description describes the program’s goals, how we review and make decisions about requests for services, requirements for UM staff, the appeals process, and more. If you have questions about our UM Program Policy, please call Member and Recipient Services at 1-800-962-9003 for more information.