Innovative Management Systems’ Contracting Department serves an integral role in network management. Services include building, expanding, and maintaining a comprehensive physician and ancillary provider network to ensure that all necessary services are available to the patient population. Our Contracting Department carefully examines key aspects of each contract to protect our managed groups and patients’ best interests.

Interested in joining our network? Please send your inquiries to contractingdepartment@imsmso.com or contact the Contracting Department direct line at 323-579-0700.

IMS offers credentialing and re-credentialing for providers and facilities. The team conducts monthly monitoring of the network and maintains records to ensure all expiring documents remain current and up to date. IMS can assist with provider directories and work as the liaison between the payers and physician groups to ensure all changes to the network are updated within contracted time frames.

IMS works directly with CAQH, a NCQA accredited Credentialing Verification Organization and national self-attested Provider Database, housing one million completed records across the nation. If you are looking to build a network or join a network, utilizing CAQH can help expedite the process and save on administrative efforts. Most payers will accept the CAQH application in lieu of their Credentialing application. This means that participating Providers will never have to complete another Credentialing application again, reducing administrative burden.

Don’t have an account with CAQH? IMS will help you create one if you don’t have the time. Simply email our friendly Credentialing Specialists at  credentialing@imsmso.com to obtain assistance or visit CAQH to register your account. You can also re-attest to your existing account and/or provide IMS access to your account if global access wasn’t already provided.

The Credentialing Committee is a non-biased diverse group of Providers contracted with IPAs managed by IMS for peer review. The Credentialing Committee meets on a monthly and ‘as needed’ basis to review the completed files and to make appropriate recommendations to the Boards. IMS also provides continuous monitoring of all expirables and daily sanction monitoring.

IMS provides extensive training to our Customer Service team to equip them with the knowledge and tools needed to offer meaningful and positive member and provider experiences. Our team takes full advantage of each opportunity to speak to a provider, member, caregiver, or family member by using motivational interviewing techniques to better understand the reason for the call, and to successfully resolve issues on the spot. Our Customer Service application was strategically selected to offer additional information to our Customer Service representatives. This provides our team with a complete view of each caller, to assist in addressing the member or provider’s outstanding needs. Our Customer Service team will always go the extra mile for each call to ensure that every caller feels valued and important.

Our Customer Service team is equipped to provide the most up-to-date member information to our physicians who are calling about Eligibility. Our Customer Service team and online Provider Portal will offer Primary Care Physicians (PCP) real time eligibility lists and reports regarding Health Risk Assessments (HRAs).

Questions? Please call us at 323-800-8283 to speak with our Customer Service Representatives, Monday – Friday from 8:00 – 5:00 PM PT.

IMS’ Provider Relations team works to support and keep our physicians current with managed care policies. By providing management services that assist providers with the administration of their practice, physicians can focus their attention solely on providing high quality care to their patients. Our Provider Portal’s advanced features ensure that Providers stay up-to-date with all of the latest information, have the ability to self-manage their accounts, and receive real-time status updates on authorizations and claims.

IMS’ Provider Relations team can assist physicians and office staff in the following areas of operations:

• New Provider Orientation; Office Staff Training
• Routine on-site visits to meet with physicians and office staff
• Web Portal & Other Web Based Meetings
• Solutions for utilization management, claims, capitation, eligibility, quality improvement, reimbursement, and other network operations areas
• Quality/HEDIS/STAR measures resources
• Compliance education and materials
• State, Medicare, and/or Health Plan policy updates
• Assistance with any demographic changes

Interested in adding a Provider or looking to join the network? Contact our Contracting Department at contractingdepartment@imsmso.com contact the Contracting Department direct line at 323-579-0700.

All decisions are reviewed by our UM Department using evidence-based criteria and guidelines, and/or based on the member’s Health Plan’s Evidence of Coverage benefits. To discuss denials, obtain an appeal, or discuss criteria please call our Customer Service Team at 323-800-8283.

• IMS’ UM Criteria is available here: IMS UM Clinical Criteria Application
• Apollo Clinical Criteria is publicly available here: Apollo Guidelines (apollomanagedcare.com)

Prior Authorization Processing Timelines:

• Routine and Retro Authorization decisions and notifications will be made no later than 14 calendar days from the receipt of the request.
• Expedited Authorization decisions will be made within 72 hours.

Part B Drugs:

• Standard Authorization decisions will be made within 72 hours.
• Expedited Authorization decisions will be made within 24 hours.

*Failure to obtain prior authorization may result in an administrative denial of the claim with no review of medical necessity.

Prior Authorization Process: Providers can request prior authorization through the provider portal. If you do not have access to the portal or in urgent cases, you may also submit your request using an Authorization Request Form. Please fax this form along with the clinical notes to the assigned IPA’s fax number. Refer to the table below for more details.

Important Notes on Authorization

• Authorization does not ensure payment. The patient must be eligible with the IPA on the service date.
• Authorizations are valid for 90 days, contingent on the patient’s eligibility.
• Providers must verify the patient’s eligibility before providing services.

Post-Stabilization Care Services

• If a hospital fails to contact IMS for pre-approval of post-stabilization care services within one hour of the request, coverage may not be provided. These services are necessary to maintain or improve a stabilized condition following an emergency.

Inpatient Admission

• Notification of inpatient admission is required within 24 hours of pre-approved admission. Please include the Face sheet and any relevant clinical documentation.

All IPAs managed by Innovative Management Systems adhere to federal Medicare regulations regarding financial responsibility for post-stabilization care services, whether within or outside the IPA network.

Clinical criteria related to a utilization decision is made available to Members, Providers, and the public, and may be requested by contacting the Utilization Management Department. Requests may be submitted via fax, portal, or by phone at 323-800-8283 or toll free at 1-800-285-6164.

IMS employees who are in a 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 criteria and guidelines, and/or based on the member’s Health Plan’s Evidence of Coverage benefits.

To discuss denials, obtain an appeal, or discuss criteria please call our Customer Service Team at 323-800-8283.

For a copy of the IMS Affirmative Statement, click here.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created primarily to modernize the flow of healthcare information, stipulate how Personally Identifiable Information maintained by the healthcare industries should be protected from fraud and theft, and to address limitations on healthcare insurance coverage.

For more information on HIPAA compliance, please contact us at 323-800-8283.

• 2022 IMS HIPAA & Cybersecurity Training v1

This notice is effective October 1, 2020. Please note that Innovative Management Systems (“IMS”) never markets or sells personal information.

There are two types of accounts for the Provider Portal: Administrative Access account and one for a Restrictive Access account. Please fill out a form for each staff member at your organization who will need access and send it back to providerrelations@imsmso.com. If you have any issues or questions, please call IMS MSO at 323-800-8283. Once the account is created, an email with the log in information will be sent to the respective user’s email address.

• • The Administrative Access will encompass all the modules in the restricted access but also have the all admin rights. Administrative Access is for the Doctors, Office Managers or Owner who will want to have full overview of all the activity going on. Individuals with full access will be responsible for managing all the permissions for everyone within your office, such as adding/removing users, resetting passwords for anyone in the office including 3^rd party billers or other vendors. You may also have more than one person with Administrative Access as well

Along with the login information, we will also provide step-by-step tutorials in PDF format. If your office requires additional training on navigating the QuickCap portal, please contact our customer service team at 323-800-8283 or reach out to us at providerrelations@imsmso.com.