Affirmative Statement Regarding Incentives

Posted on June 16, 2015

• HNE 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.
• HNE 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 HNE Provider Manual, HNE Intranet and in ALL editions of ALL HNE member newsletters

Categories: MemberMatters - Be Healthy, Newsletter