Attention all members, practitioners, providers and employees:
Santa Clara Family Health Plan affirms that:
- Utilization Management (UM) decision-making is based only on appropriateness of care and services 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.
- Incentives, including compensation, for any person are not based on the quantity or type of denial decisions rendered.
For questions regarding this statement please call the Utilization Management Department at 1-408-874-1821.