To contact Utilization Management (UM) staff regarding UM questions or a free copy of criteria used to make medical necessity decisions during the utilization review process, please call the following number: 1-888-936-PLAN (7526). Staff are available to answer UM questions from 8:00 AM – 5:00 PM, Monday through Friday. Customer Services Representatives are available to answer general inquiries about UM issues such as the status of your request for approval of a service. For more specific UM questions regarding detailed clinical information or discussion about specific UM, Customer Service Representatives will transfer you to speak directly with Medical Management staff.
HPSJ staff are also available outside of normal business hours. HPSJ staff can receive calls regarding UM issues before 8:00 AM and after 5:00 PM. Callers who need assistance after normal business hours may leave a message via a secure Customer Services voicemail line. All voicemail messages are retrieved each day at 8:00 am. Responses to voicemails are returned no later than the next business day.
For members with hearing or speech impairments, HPSJ provides Telecommunications Device for the Deaf (TDD) and/or Telephone Typewriter (TTY) services. Please contact: (209) 942-6306. HPSJ also offers language assistance to discuss UM issues free of charge.