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2025 information about our clinical programs
August 4, 2025
This article is for all providers caring for our members
We want you to know that the following information is available on our website.
| Programs & guidelines | To learn more, go to |
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Health management programs Resources about case management, care management for chronic conditions, and referrals. |
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Member rights and responsibilities Information about access-to-care and member rights and responsibilities. |
To get a paper copy, please call us at 1-800-882-2060. |
About our utilization management standards
As part of our compliance with NCQA, we want providers to understand our standards for utilization management.
- We encourage appropriate use and discourage over- and under-use of health care services.
- We do not reward or offer financial incentives to utilization management staff to encourage decisions that result in under-utilization of care.
- We do not specifically reward practitioners or other individuals for issuing denials of coverage.
- We do not incentivize or encourage barriers to care and service.
- Utilization management decision-making is based only on appropriateness of care and service and existence of coverage.
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