Effective 7/1/25, Evolent Specialty Services, Inc., will now manage the Utilization Review of cardiology services and procedures, taking the place of TurningPoint Healthcare Solutions, LLC. After 7/1/25, prior authorizations for applicable non-emergent, cardiology services must now be requested through Evolent. This change applies to Superior HealthPlan Medicaid (STAR, STAR Health, STAR+PLUS), STAR+PLUS Medicare-Medicaid Plan (MMP) and Wellcare By Allwell Medicare members aged 21 and older, and Ambetter from Superior HealthPlan members aged 18 and older.
Payor Relations works to support the Managed Care Department and UTMB by acting as a liaison between the hospital system and the insurance company (Payor/Payer). This small team handles several key responsibilities to ensure proper communication and escalation of issues between both parties.
