Prominence Health Plan distributes annually an affirmative statement about incentives to all members and to all practitioners, providers and employees who make utilization management decisions, affirming the following:
- Utilization Management (UM) decision-making is based only on appropriateness of care and services and existence of coverage.
- The organization does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.
- Financial incentives for UM decision makers do not encourage decisions that result in underutilization.
- Incentives, including compensation, for any person are not based on the quantity or type of denial decisions rendered.
For questions regarding this statement please call the Prominence Health Plan Utilization Management Department at 844-894-8086.