Affirmation Statement

Utilization Management (UM) decision making is based only on appropriateness of care and service and existence of coverage.
Avanta IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.
Avanta 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 decisions that will not influence hiring, compensation, termination, promotion, any other similar matters.

Utilization Management

Members and Providers may request a copy of the criteria used in the decision-making process by calling us at the number below or by fax.

Phone: (714)-422-0630

Fax: (714) 422-0633

Via TDD/TTY

Call the TTD/TTY number on your Member ID card or dial 711 for

Telecommunications Relay Service

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. An After-Hour nurse is available after 5:00pm to assist Members after normal business hours, Weekends and Holidays.