Utilization Management decision making is based only on appropriateness of care and service and existence of coverage. The Humboldt IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or services. The Humboldt IPA does not offer financial incentives to UM decision makers that encourage decisions that result in under-utilization.
- Utilization Management Policy & Procedures
- Standing Specialist Referral Policy
- Humboldt IPA Quality and Medical Management Program