Affirmative Statement Regarding Incentives

Posted on October 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.

Member Services
If you would like to learn more about any of the information included in this newsletter, or if you have questions about your plan benefits, feel free to contact Member Services at (413) 787-0010 or toll-free at (877) 443-3314 (TTY: 711). We are available Monday through Friday, 8 a.m. – 8 p.m. (Oct. 1 – Feb. 14: 8 a.m. – 8 p.m., seven days a week).

Categories: MemberMatters - Medicare