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

Contact Information for Non-Contracting Hospitals Post Stabilization Care or Transfer Request

During Business Hours: A non-contracting hospital can call the Alliance Authorization Unit when the hospital determines that a member is stable for transfer or to obtain authorization for post stabilization care. The non-contracting hospital only needs to make one call to the Alliance to request prior authorization for post-stabilization care. If the Alliance does not respond to the request within 30 minutes, the post-stabilization care shall be deemed as approved. The Authorization Unit Coordinator will confirm the member’s eligibility and forward the information to an Alliance Utilization Management (UM) Nurse. The Alliance UM nurse will perform a telephonic review of the member’s current medical conditions and coordinate any necessary post stabilization care. To contact the Alliance Authorization Unit, please call:

Alliance Authorization Unit
Phone Number: 1.510.747.4540
Toll-Free: 1.877.897.4388

After Business Hours, Weekends, and Holidays: A non-contracting hospital can call the Alliance On-Call Nurse when the hospital determines that a member is stable for transfer or to obtain authorization for post stabilization care. The non-contracting hospital only needs to make one call to the Alliance to request prior authorization for post-stabilization care. If the Alliance does not respond to the request within 30 minutes, the post-stabilization care shall be deemed as approved. The first day of post-stabilization will be authorized if the member is eligible with the Alliance on the date of service. The Alliance will follow-up with the non-contracting hospital on the next business day with the authorization number. To contact the Alliance On-Call Nurse, please call:

Alliance On-Call Nurse
Phone Number: 1.510.326.5271

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).