Avanta IPA

Site name

Affirmation Statement

• UM decision making is based only on appropriateness of care and service and existence of coverage

• IPA does not specifically reward practitioners or other individuals for issuing denials of coverage of care

• IPA does not offer financial incentives to UM decision makers that encourage decisions that result in underutilization

• Our practitioners are ensured independence and impartiality in making referral decision that will not influence hiring, compensation, termination, promotion or any other similar matters.

UM Communications

Utilization Management Staff are available from 8:00 am –5:00 pm Monday through Friday to answer Member and Provider questions related to the authorization and referral processes. After-Hour nurse is available after 5:00pm Monday through Friday, Weekends and Holidays for Urgent patient issues.

Utilization Management

Please contact us for any referral or authorization questions. You may request a copy of the criteria used in the decision-making process.

(858) 519-1810 Direct line

(858) 790-1810 Toll-Free

Via Fax

(858) 519-1811

Via Email

referrals@mhmhealth.com

Via TDD/TTY

Call the TDD/TTY # on your Member ID card or

dial 711 for Telecommunications Relay Service

UM related calls from practitioners, ancillary service providers, facilities and members
will be directed to the UM Department

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