Utilization Management Service Application

Streamline Your Utilization Management Provider Selection with Paperform

Finding the right utilization management (UM) service provider is critical for healthcare organizations, insurance companies, and managed care entities. Whether you're a health plan administrator, medical director, or procurement specialist, you need a systematic way to evaluate vendors based on clinical criteria, authorization processes, peer review capabilities, and performance outcomes.

This Utilization Management Service Application template gives you a professional, HIPAA-friendly framework to collect comprehensive information from prospective UM vendors. Instead of juggling email chains, spreadsheets, and inconsistent PDF submissions, you'll have one standardized form that captures everything you need to make informed decisions.

What Makes This UM Service Application Template Essential

Healthcare vendor selection demands rigor, especially when it comes to utilization management services that directly impact patient care, authorization decisions, and claims outcomes. This template is designed specifically for:

• Health insurance companies evaluating new UM vendors or re-credentialing existing providers
• Managed care organizations expanding their provider network
• Third-party administrators (TPAs) sourcing utilization review capabilities
• Hospital systems and integrated delivery networks seeking external UM support
• Healthcare procurement teams standardizing vendor intake processes

The form captures critical operational details including clinical criteria sets (InterQual, MCG, Milliman), authorization turnaround times, peer-to-peer review availability, appeal handling procedures, concurrent review methodologies, and historical denial rate performance—all the information your clinical and compliance teams need to assess vendor suitability.

How Healthcare Organizations Use This Template

For Health Plan Medical Directors: Quickly assess whether prospective UM vendors use evidence-based clinical criteria, offer appropriate peer review access for challenging denials, and maintain denial rates that align with your quality and member satisfaction goals.

For Procurement and Contracting Teams: Standardize vendor intake across all UM service categories (pre-authorization, concurrent review, retrospective review, case management) while ensuring you collect the compliance documentation, insurance certificates, and performance metrics required for contracting.

For Quality and Compliance Officers: Verify that vendors have robust appeal processes, appropriate clinical staffing credentials, technology capabilities for real-time data exchange, and transparent performance reporting that supports NCQA accreditation and regulatory requirements.

Key Features Built Into This Template

This template goes beyond basic contact information to capture the specialized details that matter in utilization management:

• Service scope and capabilities including authorization types, review levels, and specialty coverage
• Clinical criteria and evidence base to ensure alignment with your organization's standards
• Staffing credentials and peer review availability for physician-to-physician consultations
• Technology and integration capabilities including EHR connectivity, portal access, and real-time status updates
• Turnaround time commitments for urgent, standard, and expedited reviews
• Appeal and grievance processes with clear escalation pathways
• Performance metrics and denial rates with historical data and benchmarking
• Compliance certifications including URAC, NCQA, and state-specific requirements

Why Paperform is Perfect for Healthcare Vendor Applications

Healthcare procurement requires attention to detail, compliance awareness, and seamless collaboration across clinical and administrative teams. Paperform delivers:

Professional, Brand-Aligned Forms: Create applications that reflect your organization's standards with custom branding, logos, and formatting that looks polished and inspires vendor confidence.

Conditional Logic for Relevant Questions: Use smart branching to show follow-up questions based on services offered, clinical criteria used, or technology capabilities—keeping the application focused and reducing unnecessary friction for vendors.

Secure File Uploads: Collect required documentation like insurance certificates, clinical criteria samples, URAC accreditation letters, and performance reports directly within the application, eliminating email attachments and scattered files.

Automated Workflows with Stepper: Once a vendor submits their application, use Stepper to automatically route submissions to the right review committees, trigger compliance checks, update your vendor management system, and keep stakeholders informed without manual coordination.

Collaboration and Review: Export submissions to Google Sheets or Airtable for collaborative evaluation, or integrate with your CRM to track vendor relationships and contracting status over time.

SOC 2 Type II Compliance: Paperform's enterprise-grade security framework gives you confidence that sensitive vendor information is protected throughout the application and evaluation process, meeting the security standards healthcare organizations require.

Extend Your Vendor Management Process

This utilization management application is just the beginning of your vendor lifecycle. After initial evaluation and approval:

• Use Papersign (papersign.com) to send service agreements, BAAs (Business Associate Agreements), and SLAs for secure eSignature, keeping contract execution linked to the original application.
• Build Stepper workflows (stepper.io) to manage ongoing performance monitoring, quarterly business reviews, and re-credentialing processes that keep your UM vendor relationships compliant and high-performing.
• Create additional Paperform templates for vendor performance evaluations, member complaint tracking, and peer review request forms that work together as a complete vendor management ecosystem.

Built for Healthcare Procurement Teams

Whether you're managing a small health plan or a large integrated delivery network, standardizing your utilization management vendor intake saves time, improves evaluation consistency, and demonstrates your commitment to evidence-based, high-quality care management partnerships.

This template is ready to use out of the box and fully customizable to match your organization's specific clinical criteria preferences, compliance requirements, and vendor evaluation rubrics. Get started today and bring structure to your UM vendor selection process with Paperform.