{"id":4925,"date":"2016-10-01T08:00:44","date_gmt":"2016-10-01T08:00:44","guid":{"rendered":"http:\/\/hnetalk.com\/member\/?p=4925"},"modified":"2016-09-29T16:43:39","modified_gmt":"2016-09-29T16:43:39","slug":"affirmative-statement-regarding-incentives-7","status":"publish","type":"post","link":"https:\/\/hnetalk.com\/member\/affirmative-statement-regarding-incentives-7\/","title":{"rendered":"Affirmative Statement Regarding Incentives"},"content":{"rendered":"<ul>\n<li>Health New England makes utilization decisions based on appropriateness of care and service\u00a0and existence of coverage.<\/li>\n<li>There are no specific rewards to practitioners or other individuals conducting utilization review\u00a0for denials of coverage or service care.<\/li>\n<li>Health New England does not provide financial incentives for Utilization Management (UM)\u00a0decision makers that encourage or result in under-utilization.<\/li>\n<li>Practitioners are ensured independence and impartiality in making referral decisions. Those\u00a0decisions will not influence hiring, compensation, termination, promotion or any other\u00a0similar matter.<\/li>\n<li>This statement covers any practitioner, provider, staff member or delegate who makes\u00a0UM decisions.<\/li>\n<li>This statement appears at minimum in the Health New England Provider Manual,\u00a0Health New England Intranet and in all editions of all Health New England member newsletters.<\/li>\n<\/ul>\n<hr \/>\n<p><strong>Member Services<\/strong><br \/>\nIf you would like to learn more about any of the information included in this newsletter, or if you\u00a0have questions about your plan benefits, feel free to contact Member Services at (413) 787-0010\u00a0or toll-free at (877) 443-3314 (TTY: 711). We are available Monday through Friday, 8 a.m. &#8211; 8 p.m.\u00a0(Oct. 1 &#8211; Feb. 14: 8 a.m. &#8211; 8 p.m., seven days a week).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health New England makes utilization decisions based on appropriateness of care and service\u00a0and existence of coverage. There are no specific rewards to practitioners or other individuals conducting utilization review\u00a0for denials of coverage or service care. Health New England does not provide financial incentives for Utilization Management (UM)\u00a0decision makers that encourage or result in under-utilization. Practitioners [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":4926,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[17],"tags":[],"class_list":["post-4925","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicare"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/member\/wp-content\/uploads\/2016\/09\/MEDI2538-1016_Print-18.jpg?fit=600%2C371&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZGa-1hr","_links":{"self":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/4925","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/comments?post=4925"}],"version-history":[{"count":2,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/4925\/revisions"}],"predecessor-version":[{"id":4975,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/4925\/revisions\/4975"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media\/4926"}],"wp:attachment":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media?parent=4925"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/categories?post=4925"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/tags?post=4925"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}