Affirmative Statement about Utilization Management Incentives
| Date: | November 1, 2017 |
| To: | Health Plan of San Joaquin (HPSJ) Providers and Practitioners |
| From: | Medical Management Department |
| Subject: | Affirmative Statement about Utilization Management Incentives |
| Business: | Medi-Cal |
Effective: January 1, 2018
Health Plan of San Joaquin’s mission is to continuously improve the health of our community. HPSJ supports its mission through our vision statement which is to provide health care value and advance wellness.
Our affirmation statement about Utilization Management Incentives is clearly understood by all HPSJ staff involved in UM decision making as follows:
- UM decision making is based only on appropriateness of care and services and existence of coverage.
- HPSJ 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 under utilization.
If you have any questions or need assistance, please contact our Provider Services Department at 209-942-6340.