Member Resources
California Department of Developmental Services Regional Centers
Download PDFChild Health And Disability Prevention (CHDP) Program
Download PDFDiabetes Education and Smoking Cessation
Download PDFDietary Guide for Americans
Visit WebsiteEnd of Life Care
Download PDFHealth Information
Initial Health Assessment Guidelines
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Medi-Cal Early & Periodic Screening Diagnosis & Treatment For Children & Young Adults
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Mental Health and Substance Abuse
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WIC Program Guide
Download PDFVoluntary Products Recall – Philips Respironics
Download PDFAmerican Specialty Health Guideline (Chiro/Acupuncture/Physical Therapy/Speech Therapy/Occupational Therapy)
Visit WebsiteCMS Criteria
Visit WebsiteCarelon Clinical Guidelines
Visit WebsiteDHCS Criteria
Visit WebsiteEviCore Clinical Guideline
Visit WebsiteFinancial Incentive Attestation
Astrana Health’s procedures for reviewing the appropriateness of care are aimed at promoting quality of care and efficiency within the health care delivery process. We recognize the need for concern about the potential for under-utilization and appropriately review, which includes, but is not limited to bed day reports, lengths of stay reports, pharmacy usage reports, and data on member concerns regarding access to services.
As a matter of policy, associates who make utilization management coverage decisions for Astrana Health may not be compensated or given other incentives to make denial decisions. Utilization decision-making is based only on the appropriateness of care and services.
Quality Management Program & Policies
Quality Management Program, Policies and Procedures are available upon request to members and providers by calling our Customer Service department at (877) 282-8272 Opt. 1, Monday-Friday between 9:00 AM to 5:00 PM PT.
Utilization Management Policies
Procedures and Criteria are disseminated to members and providers upon request by calling our Customer Service department at (877) 282-8272 Opt. 1, Monday through Friday between 9:00 AM to 5:00 PM PT. For the hearing impaired, please call our TTY telephone at 877-735-2929, Monday through Friday between the hours of 8:30 AM to 5:00 PM PT.
A requesting practitioner may call Astrana Health to discuss a denial, deferral, modification, or termination decision with the physician (or peer) reviewer at (877) 282-8272 ext. 6195; Monday through Friday between the hours of 9:30 AM to 2:30 PM PT. All calls will be returned within 24 hours.