SCCIPA Maintains Proper Utilization Incentive Programs

In Accordance with the National Committee for Quality Assurance (NCQA), SCCIPA Maintains Proper Utilization Incentive Programs:



  1. SCCIPA’s Utilization Management program description, policies, and practitioner contracts do not contain language with improper utilization incentive programs.

  2. Terms under which a SCCIPA practitioner may be entitled to a bonus or incentive pay do not influence a practitioner’s decision to withhold, delay, or deny necessary service.

  3. SCCIPA’s utilization management decision making is based only on appropriateness of care and service, and existence of coverage.

  4. SCCIPA does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.

  5. SCCIPA does not offer financial incentives to utilization management decision makers that encourage decisions that result in underutilization.

  6. SCCIPA practitioners are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion, or any other similar matters.