Affirmative Statement about Utilization Management Incentives
| Date: | November 10, 2016 |
| To: | Health Plan of San Joaquin (HPSJ) Providers |
| From: | Medical Management Department |
| Subject: | Affirmative Statement about Utilization Management Incentives |
| Business: | Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM |
The mission of Health Plan of San Joaquin 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 (UM) 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 underutilization
If you have any questions, please contact our Provider Services Department at 209-942-6340.