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2024 information about our clinical programs

July 23, 2024

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.	Member Rights & Responsibilities. This document explains rights and responsibilities for commercial members. For Medicare Advantage members, please refer to our Evidence of Coverage documents. Log in and go to Office Resources>Policies & Guidelines>Provider Manuals See Member Rights and Responsibilities For Medicare Advantage members, please refer to our Evidence of Coverage plan documents. To get a paper copy, please call us at 1-800-882-2060.

Programs & guidelines

To learn more, go to

Health management programs

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

Member rights and responsibilities

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

Member Rights & Responsibilities. This document explains rights and responsibilities for commercial members.
For Medicare Advantage members, please refer to our Evidence of Coverage documents.

See Member Rights and Responsibilities
For Medicare Advantage members, please refer to our Evidence of Coverage plan documents.

To get a paper copy, please call us at 1-800-882-2060.

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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