Clinical Resources

Clinical Practice Guidelines 

Preventive Health Guidelines 

Member Handout on Preventive Health Care Guidelines (English) 

Member Handout on Preventive Health Care Guidelines (Spanish) 

Utilization Management

Utilization Management requests are initiated by providers by either phone or faxing the request for prior authorization form to the intake department.

  • Intake phone number: 1-855-879-7178
  • Intake fax number: 1-855-879-7180
  • Intake fax number for concurrent review (inpatient requests): 1-855-723-5102

Concurrent stay Requests are initiated when a member is currently in the hospital bed and reviewed within 24 hours.

Prior authorization requests are initiated before outpatient services have been provided and are reviewed as follows:

  • Routine request: within three business days
  • Urgent request*: within 72 hours

Please have the following information available when calling the intake department at 1-855-879-7178:

  • Member name and identification number
  • Diagnosis code(s)
  • Procedure code(s)
  • Date of service
  • Primary care physician, specialist and facility names
  • Clinical justification for request
  • Treatment and discharge plans (if known)

Services requiring prior authorization 

* Urgent Prior Authorization is defined as a condition that a delay in service could result in harm to a member.