Delegated Management Vendors in Utilization Management

This issue brief presents findings from the 2022 CAQH Index, focusing on the interaction between health plans and delegated management vendors (DMVs) in the context of utilization management (UM) and prior authorization (PA) services. It outlines the delegation process where health plans assign specific functions to vendors to alleviate administrative burdens and enhance efficiency. The report highlights that less than a quarter of plans and providers engage with DMVs for medical services, with plans averaging six vendors annually and providers interacting with approximately 22. It details the methods used by DMVs to request information, noting a predominance of manual communication methods such as fax and phone calls, with limited electronic exchanges. The findings underscore the potential for automation to streamline data requests, thereby reducing administrative workload and improving the accuracy and timeliness of information exchange. The document concludes with a discussion on the need for standardized processes to enhance interactions between DMVs and providers.