Welcome patients! This page contains helpful resources for managing your health and navigating managed care. As always, feel free to contact us if you have questions or concerns.
Members have the right to be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
By creating an Advanced Health Care Directive, you can let your physician, family, and friends know your health care preferences, so in the event that you become incapacitated, you can ensure
As a utilization management organization, ProcareMSO on behalf of Premier Patient Care IPA ensures that all decisions are made based on the available medical information at the time of the request. Should a member ask to see the criteria utilized to make a medical decision; the statement below is attached to that guideline, as required by the National Committee for Quality Assurance (NCQA):
Decisions regarding requests for medical care are based on the medical necessity of the request, the appropriateness of care and service and existence of coverage. There is no monetary reward for non-approval of services. Compensation for individuals who provide utilization review services does not contain incentives, direct or indirect, for these individuals to make inappropriate review decisions.
Utilization review criteria, based on reasonable medical evidence and acceptable medical standards of practice (i.e. MCG and/or applicable CMS and health plan guidelines) are used to make decisions pertaining to the utilization of services. Review Criteria are used in conjunction with the application of professional medical judgment, which considers the needs of the individual patient and characteristics of the local delivery system.