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UTILIZATION MANAGEMENT POLICY


Procedures and Criteria are Disseminated to Members Upon Request.

Disclosure Notice:

The materials provided to you are guidelines used by the medical group to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and benefits covered under your contract. Those are guidelines and do not constitute the standard of care.

  • Facey Medical Group will disclose a list of network providers to members, upon request.
  • Utilization Management medical clinical guidelines will be disclosed to members and practitioners, upon request.
  • All Utilization Management decisions are based on appropriateness of care and service.
  • Facey Medical Group/Foundation does not compensate practitioners for individual denials.
  • Facey Medical Group/Foundation does not offer incentives to encourage denials.
  • Facey Medical Group/Foundation does not have the financial incentives that would encourage decisions that would impact under/over-utilization of care, service or available member benefits.

For questions or concerns that are related to a referral that your provider has submitted, patients can telephone our main Utilization Management number, 818-837-5660. Hearing or speech-impaired members (TTY users) can call 711 relay services. Collect calls are accepted for patient referral matters, and Spanish speaking staff members are available.

If a patient wishes to file a grievance: Contact one of our Patient Liaison Offices.

 

Facey Office

Phone Number

Burbank

818-869-7614

Canyon Country

661-250-5203

Copper Hill

661-513-2100

Mission Hills

818-869-7018

Mission Hills Annex

818-869-7018

Northridge

818-743-5716

Porter Ranch

818-403-2418

Simi Valley

805-206-2000

Tarzana (Ob/Gyn & Pediatrics)818-466-7700

Valencia I

661-222-2608

Valencia Specialty & Women's Care Center

661-481-2446



Again, collect calls are accepted by the Utilization Management Department only for Patient Referral. The general number is: 818-837-5660.

 

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