Sutter Care Coordination

Sutter Health reviews clinical information from practitioners and providers during the authorization review process. Confidentiality is vital to the effective management of the authorization review process. All staff involved in the decision-making process sign forms agreeing to:

• Respect and maintain the confidentiality of all discussions, records and information generated in connection with the utilization management activities
• Make no voluntary disclosure of the information, except to those persons authorized to receive it. This information includes, but is not limited to, protected health information (PHI), Medical Record Information, personnel information, and business operations information.

Sutter Health ensures that decisions are made only on appropriateness of care, or service, and existence of coverage. UM staff and providers do not receive any direct or indirect compensation or financial incentive based on review decisions.

Practitioners do not receive incentives for issuing denials of coverage or service or encourage decisions leading to underutilization.

Members have a right to have an external review of the final determination.

Click here to learn about clinical guidelines.

Members, practitioners or the public should direct all requests either in writing or by telephone to Utilization Management at the contact information below.

AT&T TDD/TTY services for the deaf are available by dialing 711 or through the California Relay by calling 800-855-7100, or their Spanish speaking dedicated number 800-855-7200.

Members or their legal guardians may designate, in writing, a representative to act on their behalf.