West Regional Physicians Network (WRPN)

Utilization Management (UM) decision making is based only on appropriateness of care and service and existence of coverage. WRPN IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.

WRPN IPA does not offer financial incentives to UM decision makers that encourage decisions that result in under utilization. Our practitioners are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion any other similar matters.

Utilization Management

Quality and Utilization Management Programs A copy of the criteria used for a referral decision

Members and Providers may request a copy of the criteria used in decision-making process

UM Communications

Utilization Management Staff are available from 8:00 am –5:00 pm Monday through Friday to answer member and provider questions related to the authorization and referral processes. An After-Hour nurse is available to assist Members after normal business hours and on the weekends.