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
Important Referral 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) 499-8750.
Additionally, any Provider may contact the Physician who reviewed any specific approved or denied referral determination directly by calling (480) 499-8720.