2018 Utilization Management Affirmative Statement concerning utilization management decisions
The following statements govern Anthem Blue Cross and Blue Shield Healthcare Solutions, as a corporation and as individuals, involved in utilization management decisions:
- Utilization management decision making is based only on appropriateness of care and service and the existence of coverage.
- We do not specifically 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 utilization management decision makers do not encourage decisions that result in underutilization or create barriers to care and service.
ANVPEC-0558-18 July 2018
August 2018 Anthem Provider Newsletter - NV