- UM decision making is based only on appropriateness of care, service and existence of coverage.
- Serra Medical Group, Inc. 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.
- Serra Medical Group, Inc. distributes a statement affirming that UM decision making is based only on appropriateness of care and service and existence of coverage; SMG does not specifically reward practitioners or other individuals for issuing denials of coverage or service care; financial incentives for UM makers do not encourage decisions that result in underutilization to:
* Practitioners
* Providers
* Employees
* Employees
- Signage posted (English/Spanish) on every floor , Web and available upon request.
- Practitioners and staff sign affirmative statements annually during the QI meeting.
AVAILABILITY OF UTILIZATION CRITERIA
Members can obtain UM criteria upon request. Contact the UM department at (818) 504-4569.
Criteria maybe distributed via the Internet it can also be sent in writing upon request to all participating practitioners. Contact the UM department (818) 504-4569.
The material will include the following statement:
“ The material provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual needs and the benefits covered under your contract.”
