FHC in no way rewards or incentivizes, either financially or otherwise, practitioners, Utilization Review Coordinators (URC), Physician Advisers (PA), or other individuals involved in conducting utilization review for issuing denials of coverage or service, or inappropriately restricting care. FHC does not incentive providers or practitioners to encourage barriers to care and service.
FHC utilization management (UM) and other care management staff base their utilization-related decisions on the clinical needs of the members, benefits availability, and appropriateness of care. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.
Objective scientifically based clinical criteria and treatment guidelines serve as a guide to the decision-making process in the context of the Provider or the member-supplied clinical information.