CFMG's Quality & Utilization Management

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CFMG Professional Paper Claims Address - Children First Medical Group, Inc., PO Box 99680, Emeryville, CA 94662-9680

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Contact Us

6425 Christie Ave #110
Emeryville CA 94608
Phone: (510) 428-3154
Mon-Fri 8:00am-5:00pm
Online Inquiry Form.

AUTHORIZATIONS / REFERRALS

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

CFMG's Business Hours:
Mon-Fri -- 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) and Anthem Blue Cross criteria when making Utilization Management decisions.
⚫	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).