IntegraNet Health through our agreement with Amerivantage/Amerigroup & SCAN Health–all Medicare Advantage Plans for members of our Primary Care Physicians are delegated to IntegraNet Health for Utilization Management.

Providers are solely responsible for and are strongly encouraged to verify authorization requirements prior to rendering service.

Tips

Prior authorizations denied for lack of medical necessity will be notified by phone of the determination and peer to peer with the Utilization Management Medical Director will be offered. Providers who wish to initiate peer to peer, have 24 hours from time of the notification to request peer review. Peer review can be scheduled by calling (281) 447-6800.

Appeals for administrative denials (i.e. failure to obtain prior authorization, inappropriate level of care, late notification, or referral to an out of network provider) are to be submitted to:

Appeals for lack of medical necessity denials are to be submitted to: