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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.
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