1. Utilization Management (UM) Staff is accessible via phone, fax or e-mail to discuss and / or clarify referral authorization requests and decisions. 

2. UM Staff is available during regular business hours Monday through Friday, excluding holidays, 8:30 am to 4:30 pm. 

3. Please call:  1-800-780-8879; 949-260-6500; or if you are hearing impaired, please call the TDD/TTY Language Line at 1-877-261-6608.

4.  All UM staff members have the ability to make outbound telephone calls (local or long distance) during regular business hours in support of the referral authorization process, which included communication with providers requesting services and / or members needing services.

5. All UM decision making is based only on appropriateness of care and service; and the existence of coverage.

6.  Arta Western Medical Group and Arta Health Network do not reward UM staff or physicians for issuing denials of coverage or care.

7. No offers for financial incentives are given to UM staff or physicians that would encourage decisions resulting in underutilization.

8. All licensed personnel, including the Medical Director, who make referral authorization decisions are ensured independence and impartiality in making those decisions which will not influence hiring, compensation, termination, promotion or any other similar matters.

If you need to see a specialist, please contact your Primary Care Physician (PCP) who can assess your medical condition and will determine if a referral is required.  If so, your PCP will then refer you to the appropriate contracted specialist or service provider within the IPA / network.

1. Urgent authorizations will be approved within 72 hours of submission

2. Routine authorization requests will be approved within 5 business days of submission.

3. Both you and your PCP will receive written notification when your authorization decision has been completed.