• 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.
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.
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
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