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Medicaid Utilization Review (MUR)

Medicaid Utilization Review is a multi-functional team that provides medical expertise to program areas within the Erie County Department of Social Services. MUR ensures appropriate utilization of Medicaid benefits for Medicaid Transportation, Restricted Recipient Program and Medicaid Disability.

The office is located in the Rath Building at 95 Franklin St., Buffalo, NY. The general information phone number is 716-858-4877. The fax number is 716-858-4875. The phone line is covered Monday through Friday from 8:00 a.m. to 4:00 p.m. Callers should leave a detailed message, and your phone call will be returned.

Medical Transportation:

  • Medicaid transportation can only be approved for active recipients.
  • Transportation is only allowed to Medicaid billable services.
  • Medicaid transportation is not an entitlement.
  • The Center for Transportation Excellence is the Mobility Manager for this program, its phone number is 716-838-9000.
  • The application consists of a medical forms completed and signed by a physician and a social form completed and signed by the recipient
  • Medicaid recipients may be eligible for 4 courtesy rides each calendar year, before having to submit the proper paperwork. If a courtesy ride is necessary, reservations must be called in 2 business days in advance. Transportation approvals encompass mileage reimbursement, public transportation, public not-for-profit transportation, taxi, wheelchair, straight stretcher, ground ambulance.
  • Recipients are expected to visit doctors in their Common Medical Marketing Area. Sometimes Medicaid can authorize transportation out of the CMMA for medical services not available closer.
  • Applications are processed within 4-6 weeks of completion date.

Restricted Recipient Program:

  • New York States Department of Health monitors every Medicaid recipient’s use of medical services.
  • When overutilization is found, the New York State Department of Health places the recipient into this program to reduce overutilization that could negatively impact the recipient’s health and well being.
  • Recipients may be required to select a primary medical doctor, pharmacy, dentist, and hospital for inpatient care.
  • Primary doctors must make proper referrals to specialists for this program.

Medicaid Disability:

  • MUR performs a medical evaluation in accordance with the Social Security Administration Disability regulations for Medicaid applicants who exceed the financial levels for their age under the program, and are only eligible for Medicaid if they are determined to be disabled for at least one year.