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.