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2022 information about our clinical programs
May 16, 2022

We want you to know that the following information is available on our website.

Programs & guidelines To learn more, go to
Health management programs

Resources about case management, care management for chronic conditions, and referrals.

Health Management Programs
Member rights and responsibilities

Information about access-to-care and member rights and responsibilities.

Medicare Advantage Member Policies and Procedures

Office Resources>Policies & Guidelines>Provider Manuals

See 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.