PCSD is a major force in the managed care field. Because or our commitment to the highest level of care and our wide geographic distribution, currently with 10 offices in San Diego County, since 1981 PCSD has had numerous managed care contracts with many of the major medical groups.

PCSD has established a comprehensive in-house program of quality assurance and utilization management.

PCSD fully complies with the National Committee for Quality Assurance (NCQA) written guidelines.

PCSD's Utilization Management Program covers the following:
Procedures to evaluate access, triage, and referral; medical necessity, appropriateness and efficiency of health care services, level of care and effectiveness, and processes to detect under- as well as over-utilization of services.

To view the entire UM Plan click here: UM PLAN

	Data sources and Medical Necessity/Utilization Review Criteria used in decision-making
	Review, revise, adopt Clinical Practice Guidelines annually with input from PCSD's clinicians
	Ensure distribution and implementation of the Clinical Practice Guidelines to PCSD's providers
	The process of conducting appeals of adverse Utilization Review determinations.
	Mechanisms to ensure consistent application of review criteria and compatible decisions.
	Provisions for assuring confidentiality of clinical information.
	The processes in place to periodically assess Utilization Review activities.
	The staff position functionally responsible for day-to-day Program management.
	Process in place to review all requests for new Clinical Technologies and new application of existing Clinical Technologies.