UniCare Massachusetts is now Wellpoint, effective July 1, 2024. New name, same commitment to you.

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Utilization Management

Our Utilization Management process


Wellpoint’s utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as on the member's plan coverage.

Notice regarding financial incentives

 We do not reward providers or other individuals for issuing denials of coverage, service, or care.

 We do not make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits.


 We do not offer financial incentives for UM decisionmakers to encourage decisions resulting in under‑utilization.

Medical policies and clinical UM guidelines

To request a copy of Wellpoint’s UM criteria for a specific condition, or to speak with a physician reviewer about a UM denial, contact Wellpoint Medical Management at 800‑442-9300.


Review all Wellpoint medical policies and clinical UM guidelines  

How Wellpoint responds to UM inquiries

If you have questions about our UM process and authorization of care, contact Wellpoint Utilization Management at 800-442-9300. Office hours are Monday through Thursday, 8:30 a.m. to 6:00 p.m. (ET) and Fridays, 8:30 a.m. to 5:00 p.m. (ET).


After hours, please leave a message with your contact information. Your call will be returned during normal office hours on the next business day unless other arrangements are made. Calls received after midnight will be returned the same business day. When initiating or returning calls, our Utilization Management associates identify themselves to all callers by first name, title, and company name.


Wellpoint members needing language assistance can call the toll-free Member Services phone number listed on their Wellpoint ID card.


Contact Wellpoint Utilization Management