In compliance with the National Committee for Quality Assurance (NCQA) standards, we distribute this Affirmative Statement regarding Utilization Management (UM) decisions to all members, practitioners, providers, and employees annually. In doing so, we proudly affirm our mission of improving access to quality care for all our members. We require that our employees adhere to the following principles:
- Our Utilization Management decision-making is only based on appropriateness of care and service as well as existence of coverage;
- We do not specifically reward practitioners or other individuals for issuing denials of coverage or care;
- Financial incentives for our Utilization Management decision-makers do not encourage decisions that result in underutilization.