ConnectCare's NCQA Utilization Management Certification
NCQA Utilization Management Certification focuses on consumer protection and improvement in service to customers. Standards recognize that organizations that apply for certification have open access networks, and can improve service quality and utilize customized structures to meet the purchaser needs.
Affirmative Statement About Incentives
- Utilization Management (UM) decision-making is based only on appropriateness of care and service and existence of coverage.
- ConnectCare does not specifically reward practitioners or other individuals for issuing denials of coverage.
- There are no financial incentives for UM decision-makers; therefore there is nothing to encourage decisions that result in underutilization.