Members

Utilization Management (UM) Affirmative Statement

The organization distributes a statement to all members and to all practitioners, providers and employees who make Utilization Management (UM) decisions, affirming the following:

  • UM decision-making is based only on appropriateness of care and service and existence of coverage.
  • The organization does not specifically reward practitioners or other individuals for issuing denials of coverage.
  • Financial incentives for UM decision makers do not encourage decisions that result in underutilization.