Utilization Management Information

• Upon request, you may obtain a free copy of the actual benefit provision, guideline, protocol or other similar criteria on which an approval or denial decision was based by calling Arizona Priority Care at (480) 499-8720.
• Additionally, any Provider may contact the Physician who reviewed any specific approved or denied referral determination directly by calling (480) 499-8720.

Affirmative Statement About Incentives

• Utilization Management (UM) decision making is based only on appropriateness of care and service existence of coverage
• The organization does not specifically reward practitioners or other individuals for issuing denials of coverage or service care
• Financial incentives for UM decision makers do not encourage decisions that result in under-utilization