Download Training Material here:
Staff Training & Education P&P: Download PDF
Fraud, Waste and Abuse: Download PDF
Compliance Program: Download PDF
Affirmative Statement About Incentives
The organization distributes a statement affirming that UM decision making is based only on appropriateness of care, service, and existence of coverage; the organization 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.
- Practitioners (NCQA definition – A licensed or certified professional who provides medical care of behavioral healthcare services.)
- Providers (NCQA definition – An institution or organization that provides services, such as a hospital, residential treatment center, home health agency or rehabilitation facility.)