Policies & Procedures

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.)
  • Employees
  • Members
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