Noble Mid OC ensures that members will not be discriminated against in the delivery of health care services based on race, color, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, medical or claims history or source of payment.
Noble Mid OC does not reward practitioners, providers or employees for issuing denials of coverage or service. All denials must be strictly based on insufficient medical appropriateness or not a covered benefit. Financial rewards or incentives must not influence any utilization decision. Financial rewards or incentives may be issued to encourage efficient and appropriate care. To assure that the risks of under-utilization are considered, no rewards or incentives can be issued that will discourage appropriate care and services to the members. In addition, practitioners are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion or any other similar matters.
Noble Mid OC will adhere to the following Referral Turnaround Times, except in cases where the member’s health plan dictates other specific timeliness requirements. In general, decisions will be made for Standard/Non urgent referrals within 5 business days from the date of receipt for Medi-Cal and Cal MediConnect; and within 14 days from the date of receipt for Medicare. Urgent/Expedited requests will be completed within 72 hours of day/time of request. Emergent specialty referrals requests can be phoned in and/or sent in retroactively, with description of emergent need. Retroactive requests will be responded to within 30 days of the date of receipt. All Emergencies are to be directed to call 911 or go to the closest Emergency Room.
In the event of a denial of service, you may contact the Medical Director to discuss the determination. Please contact the UM Department, Toll Free at (888) 880-8811 for assistance in connecting with the Medical Director or Physician Reviewer.
Noble Mid OC Medical Directors and Physician Reviewers will utilize approved evidenced based criteria in the decision making process. Criteria will be made available to all providers, members and the public upon any written or verbal request. The information will be provided in a timely manner either via fax or mailing. UM Criteria used in decision making can be obtained by contacting the UM Department Toll Free at (888) 880-8811.
Members and Providers can utilize (888) 880-8811, 24 hours a day/ 7 days a week for telephonic assistance or for Hearing Impaired: 711 California Relay Service.
The Utilization Management staff is available during business hours, 8:00AM-5:00PM PST. For calls after business hours, you will be connected to an On-Call representative.
Free Interpreting services are available to all members. For assistance with face-to-face interpreter services, including sign language interpreting or telephonic interpreting services, please call the Member Services Department Toll Free at (888) 880-8811.
The Health Education Department offers a wide range of health information topics to meet our members’ and providers’ needs. Noble Mid OC’s goal is to promote a healthy lifestyle and to offer preventive health education to our members. Health Education topics available include, but are not limited to, Age Specific Anticipatory Guidance, Asthma, Breastfeeding, Dental, Diabetes, Exercise/Physical Activity, Family Planning, HIV/STD Prevention, Hypertension, Immunizations, Injury Prevention, Lead Poisoning Prevention, Nutrition, Obesity, Parenting, Perinatal, Substance Abuse, Tobacco Prevention & Cessation, Tuberculosis, etc. Health Education materials are available upon request by contacting the Health Education Department Toll Free at (888) 880-8811.