Provider Policies

Financial Incentive Attestation

Network Medical Management’s procedures for reviewing appropriateness of care are aimed at promoting quality of care and efficiency within the health care delivery process. We recognize the need for concern about the potential for under-utilization and appropriately review, which includes, but is not limited to bed day reports, lengths of stay reports, pharmacy usage reports and data on member concerns regarding access to services.

As a matter of policy, associates who make utilization management coverage decisions for Network Medical Management may not be compensated or given other incentives to make denial decisions. Utilization decision making is based only on appropriateness of care and services.