Affirmative Statement Regarding Incentives

Posted on September 1, 2016

• Health New England makes utilization decisions based on appropriateness of care and service and existence of coverage.
• There are no specific rewards to practitioners or other individuals conducting utilization review for denials of coverage or service care.
• Health New England does not provide financial incentives for Utilization Management (UM) decision-makers that encourage or result in under-utilization.
• Practitioners are ensured independence and impartiality in making referral decisions. Those decisions will not influence hiring, compensation, termination, promotion or any other similar matter.
• This statement covers any practitioner, provider, staff member or delegate who makes UM decisions.
• This statement appears at minimum in the Health New England Provider Manual, Health New England Intranet and in all editions of all Health New England member newsletters.

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