Welcome to PremierCare IPA Provider Portal

In accordance with state and federal regulations, please be aware that all PremierCare IPA on behalf of all Providers and Physicians in our IPA’s network, utilization Decisions regarding requests for medical care are based on the medical necessity of the request, the appropriateness of care and service and existence of coverage. There is no monetary reward for non-approval of services. Compensation for individuals who provide utilization review services does not contain incentives, direct or indirect, for these individuals to make inappropriate review decisions.

Utilization review criteria, based on reasonable medical evidence and acceptable medical standards of practice (i.e. MCG and/or applicable health plan guidelines) are used to make decisions pertaining to the utilization of services. Review Criteria are used in conjunction with the application of professional medical judgment, which considers the needs of the individual patient and characteristics of the local delivery system.

Any Member Or Physician Looking To Obtain A Copy Of The Criteria Used To Make A Clinical Decision May Call our Customer Service Line At 657-206-8700 or email um@procaremso.com Request The Documentation Be Sent To You.

If you have not already done so, you should think about completing an Advance Health Care Directive. Also known as a Durable Power of Attorney for Health Care, an Advance Health Care Directive can help ensure that your wishes concerning your medical care are followed if you are unable to make your own health care decisions. You can designate a person to be your “agent” in making some or all health care decisions for you at any time that you may not be able to make such decisions for yourself. Your agent can be anyone over age 18, except your physician or his/her employees.