- Authorization is required for hospital admissions and certain specialty services, including outpatient services.
- Prior Authorization is obtained by means of a completed Prior Authorization Form.
- Failure to secure prior authorization before rendering services may result in denial of claims payment.
Affirmative Statement About Incentives
- Utilization Management (UM) decision-making is based only on the 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
Availability of UM Criteria Guidelines
Members, Authorized Representatives, and Practitioners may request a copy of the criteria guidelines used in making UM determination in the following methods during our business hours (Monday – Friday, 8:00 AM to 5:00 PM):
- Telephone: 480-499-8700 Ext. 8301 (TTY 711)
- Fax: 480-499-8798
- Email: firstname.lastname@example.org
- In-person: 585 N. Juniper Dr., Suite 150, Chandler, AZ 85226