New Claims System Update

9.6 Affirmative Statement About Incentives

Provider Manual
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9 Hospital and Elective Admission Management

9.6 Affirmative Statement About Incentives

IntegraNet, as a corporation and as individuals involved in UM decisions, is governed by the following statements:

UM decision-making is based only on the appropriateness of care and service and existence of coverage.

  • IntegraNet does not specifically reward practitioners or other individuals for issuing denials of coverage or care.    Decisions about hiring, promoting or terminating practitioners or other staff are not based on the likelihood or      perceived likelihood that they support or tend to support denials of benefits.
  • Financial incentives for IntegraNet UM decision-makers do not encourage decisions that result in underutilization or      create barriers to care or service.