Information to

Our providers

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

Affirmative Statement

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.

HIPAA

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.

Obtaining Decision Making Criteria

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.

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