top of page
Utilization Management Practices: 
Authorization and Referrals 

For questions please call the UM Department

Telephone:   (510) 428-3489
Fax:                  (510) 450-5868

​

CFMG will accept collect calls
For TTY Users: (800) 855-7100

CFMG's Business Hours:
Mon-Fri  --  8:00 am to 5:00 pm.

Utilization Criteria/Independent Utilization Management Decision Making

  • Children First Medical Group, Inc. uses standardized criteria from Milliman Care Guidelines (MCG) and Anthem Blue Cross criteria when making Utilization Management decisions. CFMG will provide copies of criteria to providers upon request via FAX or mail.

​

  • Utilization management (UM) decision making is based only on appropriateness of care and service and existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.

​

  • ​Practitioners are ensured independence and impartiality in making referral decisions that will not influence:​

    • Hiring

    • Compensation 

    • Termination 

    • Promotion 

    • Any other similar matters 

​

** In accordance to 29 CFR 2590.715-2719 (b)(2)9ii)(D).

bottom of page