Provider Tools

Access to Care Standards

Case Management Program

HealthNet and SCAN Model of Care Training for SNP

HIPAA

Medicare Fraud Waste and Abuse

Prescription Drug form (61-211)

US Preventative Task Force Guidelines

Affirmative Statement

1.) Utilization Management decision making is based only on appropriateness of care and service and existence of coverage.
2.) The delegate does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage.
3.) Financial incentives for Utilization Management decision makers do not encourage decisions that result in under-utilization.