NOTICE TO ALL PERSONS INVOLVED IN

UTILIZATION REVIEW (UR) - RELATED DECISIONS

NCQA UM 4 Element G

“It is the policy of HealthPartners, Inc. that utilization review decisions are made based only on appropriateness of care and service and existence of coverage.

Financial incentives, if any, that are offered by HealthPartners, Inc., or any entity that contracts with HealthPartners, Inc. to provide utilization management services, to individuals or entities involved in making utilization management decisions will not encourage decisions that result in under-utilization or inappropriate restrictions of care.

This means that HealthPartners, Inc., and entities contracting with HealthPartners, Inc. to provide utilization management services, will not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service. Rather, financial incentives, if any, will be designed to encourage appropriate utilization and discourage under-utilization.”

If you have any questions or would like a hard copy of the policy, please contact Kelsey Folin

at 952-883-5768.