FHC in no way rewards or incentivizes, financially or otherwise, Utilization Reviewers, Medical Advisors, or other individuals involved in utilization review processes to issue denials of coverage or services, or to inappropriately restrict our care. members. FHC does not incentivize providers or professionals for promoting barriers to care and service.
FHC utilization management staff or other care management members base their decisions on our members' clinical needs, availability of benefits, and the appropriateness of care. Financial incentives for utilization management personnel do not encourage decisions that result in low utilization.
Objective, science-based clinical criteria and treatment guidelines serve as guides in the decision-making process in the context of the provider or member-provided clinical information.
