Affirmative Statement Regarding Incentives

Posted on September 18, 2015

• 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.

Health New England Medicare Advantage is an HMO Plan with a Medicare contract. Enrollment in Health New England Medicare Advantage depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. 

Categories: MemberMatters - Medicare