Utilization Review Team
The Wake County LME Utilization Review team manages the utilization of state, federal and local funding by reviewing requests for mental health, substance abuse, and development disability services to determine if consumers meet established medical necessity criteria and financial eligibility. Community support workers, court counselors, child welfare workers, therapists, care coordination staff, provider agencies, and case managers submit Service Authorization Request forms and supporting documentation to the UR Team for review. Our mission is: "To serve eligible MH/SA/DD consumers and providers in Wake County by authorizing the least restrictive, clinically appropriate and medically necessary services while being good stewards of public funds." See Provider Manual, “Section III, Authorization Process,” for details.
MH/SA Care Managers on the Utilization Review team are assigned to work with service provider agencies primarily by age and disability specialty areas, although Care Managers are cross-trained to have familiarity with all available MH/SA services. DD Care Managers on the Utilization Review team review requests according to age, disability and services requested. Data Support Specialists (“DSS”) work closely with UR Care Managers and are assigned as the principal contact for service agencies in the community.
Medicaid Utilization Review is completed by the statewide vendor (Value Options).
Contact Us:
401 E. Whitaker Mill Road
Raleigh, NC 27608
Fax: 919-743-4820
For Medicaid Service Requests contact ValueOptions at 888-510-1150.
Data Support Staff
Utilization Review Staff