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Utilization Management Practices: 
Authorization and Referrals 

For questions please call the UM Department

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

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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.

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  • 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.

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

    • Hiring

    • Compensation 

    • Termination 

    • Promotion 

    • Any other similar matters 

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

  • WHAT IS THE STATUS OF MY AUTHORIZATION REQUEST?
    As a reminder, routine requests are processed within 5 working days; urgent requests within 72 hours, and post-service requests within 30 calendar days. If your request is within these time frames, please be patient.
  • HOW DO I REQUEST A DATE EXTENSION FOR AN AUTHORIZATION?
    Fax the authorization letter with your requested extension date to (510) 450-5868 or call the Utilization Management department at (510) 428-3489.
  • WHERE DO WE REFER MEMBERS WHO CANNOT BE SEEN AT UCSF BENIOFF CHILDREN’S HOSPITAL OAKLAND DUE TO AGE?
    Check the Health Plan website for a contracted provider, call the provider for availability, and submit the authorization request to CFMG.
  • HOW DO I GET A LISTING OF APPROVED CHILDREN FIRST MEDICAL GROUP (CFMG) SPECIALIST?
    At www.childrenfirstmedicalgroup.org, navigate to the “Provider Directories” in the bottom left. You can search by specialty, the doctor’s name, by city or by county.
  • HOW DO I FIND A LISTING OF CFMG OBSTETRICIAN/GYNECOLOGISTS?
    Visit AlamedaAlliance.org to find a physician. CFMG does not have OB/GYN’s in our network as OB services are Health Plan responsibilities.
  • DOES CFMG COVER PODIATRY?
    Yes, Podiatry is a Health Plan benefit for Alameda Alliance for Health, you will need to complete a CFMG Request for Authorization Form for visits. Refer to the Health Plan website for a listing of Podiatrists. CFMG does not have Podiatrists in our network.
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