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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