The Alliance Utilization Management (UM) Department works to ensure that medical services provided to our members are medically necessary, appropriate, and a part of the covered benefits. The Alliance UM Department is managed by our Health Care Services Department. The Alliance UM team is made up of authorization specialists, pharmacists, nurses, and physicians. The Alliance follows nationally recognized evidence-based criteria and considers individual member circumstances when making medical service decisions.

Contact

For the most up to date information or if you have questions, please call:

Alliance Utilization Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4540 ext. 5
Fax: 1.855.891.7174

UM Staffing and Disclaimer

The Alliance Medical Services Department employs clinical reviewers who are qualified to make UM and authorization decisions. The Alliance ensures that UM and authorization decision-making is based only on appropriateness of care and service and existence of coverage.

The Alliance does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM and authorization decision makers do not encourage decisions that result in underutilization.

For a complete list of services that require authorizations, please view the Alliance Referral and Prior Authorization (PA) Grid for Medical Benefits (for directly contracted providers only).