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Member Resources

Utilization Management

Golden Coast MSO has a Utilization Management program to ensure that members have access to quality health care. The program utilizes a team of health care professionals to evaluate the medical necessity of the services by using nationally recognized, evidence-based clinical guidelines and community standards. The decisions are based on the appropriateness of care and services available to members within their contracted benefits.

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Protected Health Information Privacy

Golden Coast MSO is required by law to maintain the privacy of “Protected Health Information” (PHI).

As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. We must comply with the provisions of this notice, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all PHI we maintain. You can always request a copy of our most current privacy notice from our Compliance Officer.

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Part-C Pre-Authorizations

As a Golden Coast MSO member you can request a self-referral (pre-authorization) to see a specialist or receive medical services and items. Typically, your provider will do this for you.

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Non-Discrimination Notice

Golden Coast MSO complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Golden Coast MSO does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

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