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Utilization Management
UM Referral Process
  1. Contracted Providers can access Connect to submit referrals
  2. Non-contracted Providers can fill out the UM TAR Form. Please click here to access the form.
  3. To contact the UM Department, please call 855-848-5252 M – F 8 am to 5 pm
UM Clinical Criteria
  1. To obtain a copy of the UM criteria used please contact the UM department at 855-848-5252 M – F 8 am to 5 pm
  2. To view the approved UM criteria list, please click here.
Prescription Drug Form
  1. To obtain a copy of the Prescription Drug Form, please click here.
  2. Needs to be sent to UM fax number 323-720-5608
Affirmative Statement
  1. The Risk Bearing Organization (RBO), c/o Altura Management Services, UM decision making is based only on appropriateness of care, service, and the existence of coverage. Additionally, the RBO c/o Altura MSO affirms:
    1. It does not award practitioners or other individuals conducting utilization review decisions that result in underutilization.
    2. UM decision making is based only on appropriateness of care and service and existence of coverage.
    3. It does not specifically reward practitioners or other individuals for issuing denials of coverage.
    4. Financial incentives for UM decision-makers do not encourage decisions that result in underutilization.
    5. Providers and practitioners are not prohibited from acting on behalf of the member
    6. Physicians cannot be penalized in any manner for requesting or authorizing appropriate medical care.
    7. Practitioners are ensured independence and impartiality in making referrals decisions that will not influence the hiring, compensation, termination, promotion, or any similar matters.
Initial Health Assessment
  1. To view the Provider Bulletin regarding Initial Health Assessments, please click here.
Medical Records
  1. To obtain a copy of member medical records, please fax your request to Altura MSO at 323-530-5701.
Standing Referrals
  1. A "standing referral" is defined as, two (2) or more visits to a specialist Care.
    1. A condition or disease that requires specialized medical care over a prolonged period of time and is life threatening, i.e. degenerative, disabling HIV infection and AIDS, must receive a referral to a specialist or specialty care center for the purpose of having the specialist coordinate the member’s health care.
  2. To obtain a copy of the Standing Referral policy call the UM department at 855-848-5252 M – F 8 am to 5 pm
Provider Peer-to-Peer Requests
  1. Altura MSO UM Department has a designated phone line to connect providers with our Physician Reviewers.
  2. This phone line may be used to contact a physician reviewer to discuss adverse determinations
  3. Direct #: 323-597-2928
Comprehensive Perinatal Services Program (CPSP)
  1. Pregnant women who are eligible for Medi-Cal can enroll in CPSP, which includes prenatal medical care, health & nutrition education, as well as support for issues like jobs, emotional well-being, and housing.
  2. Pregnant women and teens can go to CPSP sites and receive temporary Medi-Cal that same day for prenatal care. The patient must then apply for Medi-Cal. No one is excluded based on immigration status. While waiting for the reply from Medi-Cal, the clinic visits will be paid for by Medi-Cal.
  3. For additional program information, visit the CPSP Website
  4. To obtain a copy of the CPSP Provider Handbook, please click here.
  5. To obtain a copy of the CPSP Program Guidelines, please click here.
Case Management Referral Process
  1. Referrals to Case Management (CM) will be accepted via telephone, or e-mail.
    1. Telephone: 855-848-5252 M – F 8 am to 5 pm
    2. E-Mail: caremanagementdepartment@alturamso.com
  2. Providers can access the CM Referral Form here.
  1. Hospital/Emergency Room attempting to provide telephonic notification for post-stabilization must call 855-848-5252 to obtain authorization of post-stabilization care.
  2. Upon calling, follow the prompt selections to the Inpatient Department as a UM representative is available 24 hours a day, 7 days a week.
Sterilization and Informed Consent
  1. All members undergoing sterilization must give written consent via the PM 330 form and receive a copy of the Sterilization Booklet from the DHCS website.
  2. In addition to the PM 330 consent form, a member acknowledgment must be documented in the electronic medical record (EMR) confirming receipt of the booklet by the member.
  3. To obtain a copy of the Sterilization Booklet, please visit the DHCS website
  4. To obtain a copy of the PM 330 form, please click here.

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