2021 affirmative statement concerning utilization management decisions

 This communication applies to the Medicaid and Medicare Advantage programs in Kentucky.

 

All associates who make utilization management (UM) decisions are required to adhere to the following principles:

• UM decision making is based only on appropriateness of care and service and existence of coverage.
• We do not reward practitioners or other individuals for issuing denials of coverage or care. Decisions about hiring, promoting or terminating practitioners or other staff are not based on the likelihood or perceived likelihood that they support, or tend to support, denials of benefits.
• Financial incentives for UM decision makers do not encourage decisions that result in underutilization or create barriers to care and service.

 

If you have any questions about this communication:

• For Medicaid, call Provider Services at 855-661-2028.
• For Medicare Advantage, call the number on the back of the member’s ID card.

 

AKY-NU-0328-21