Utilization Management Practices:
Authorization and Referrals
CFMG UM INFORMATION / FORMS
For questions, please call
the UM Department at (510) 428-3489.
or email: CFMGUM@ucsf.edu
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
or email: CFMGUM@ucsf.edu
CFMG’s Business Hours:
Monday – Friday: 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) 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).
Frequently Asked Questions
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.
Fax the authorization letter with your requested extension date to (510) 450-5868 or call the Utilization Management department at (510) 428-3489 or email: CFMGUM@ucsf.edu
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.
At www.childrenfirstmedicalgroup.com, navigate to CFMG Home then “Provider Search” in the top menu bar. You can search by provider type, specialty, name, city or county. For Printed Directories Click on CFMG Resources, then Provider Directories in the top menu bar.
Visit AlamedaAlliance.org to find a physician. CFMG does not have OB/GYN’s in our network as OB services are Health Plan responsibilities.
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.