SCCIPA Maintains Proper Utilization Incentive Programs
In Accordance with the National Committee for Quality Assurance (NCQA), SCCIPA Maintains Proper Utilization Incentive Programs:
- SCCIPA’s Utilization Management program description, policies, and practitioner contracts do not contain language with improper utilization incentive programs.
- 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.
- SCCIPA’s utilization management decision making is based only on appropriateness of care and service, and existence of coverage.
- SCCIPA does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.
- SCCIPA does not offer financial incentives to utilization management decision makers that encourage decisions that result in underutilization.
- SCCIPA practitioners are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion, or any other similar matters.