Utilization Management decision making is based only on appropriateness of care and service and existence of coverage. The Humboldt IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or services. The Humboldt IPA does not offer financial incentives to UM decision makers that encourage decisions that result in underutilization.
PRIOR AUTHORIZATION
PLEASE NOTE – All out of area (outside of Humboldt and Del Norte Counties) and/or out of network services require prior authorization.
Click here to search by CPT code or procedure description to determine if a service requires prior authorization.
