Information to

Our providers

Please see below for information relating to providers along with provider training.

Affirmative Statement

IMS employees who are in the position to review, conduct or make medical decision 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 enrollees. Physician reviewers are not rewarded for issuing denials of coverage all decisions are reviewed using evidence-based guideline criteria and/or the members Health Plan/IPA Evidence of Coverage benefit.

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

Affirmative statement (click here)

HIPAA

The Health Insurance Portability and Accountability Act was created primarily to modernize the flow of healthcare information, stipulate how Personally Identifiable Information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and address limitations on healthcare insurance coverage. The Security Rule including who is covered, what information is protected, and what safeguards must be in place to ensure appropriate protection of electronic protected health information.

Obtaining Decision Making Criteria

Providers/Members requesting clinical criteria related to a Utilization referral decision is available to Members, Providers and the public and may be requested by contacting the Utilization department, fax, portal or by phone at 323-800-8283 or toll free at 1-800-285-6164.

Provider Training:

Provider Manual:

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