Northern California Physicians Group IPA
IMS employees who are in the position to review, conduct, or make medical decisions are not influenced by financial incentives, bonuses, or additional compensation relating to the quality of, access to, or utilization of Health Care services rendered to members. Physician reviewers are not rewarded for issuing denials of coverage. All decisions are reviewed using evidence-based guidelines, criteria, and/or the members’ Health Plan/IPA Evidence of Coverage.
To discuss denials, criteria, or to obtain an appeal, please call our Customer Service team at 323-800-8283.
Obtaining Decision Making Criteria
Clinical criteria related to Utilization referral decisions are available to Members, Providers, and the public, and may be requested by contacting the IMS Utilization Management Department, or via fax, portal, or by phone at 323-800-8283. The criteria will be delivered within one (1) business day of the request.