The organization distributes a statement to all members and to all practitioners, providers and employees who make Utilization Management decisions, affirming the following:
1. Utilization Management decision making is based only on appropriateness of care and service and existence of coverage.
2. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage.
3. Financial incentives for Utilization Management decision makers do not encourage decisions that result in underutilization.