The UM process does not contain financial incentives, direct or indirect, to influence utilization management decisions.
The nurses, medical directors, other professional providers, and independent medical consultants who perform utilization review services for SFHP are not compensated or given incentives based on their coverage review decisions.
SFHP does not specifically reward or provide financial incentives to individuals performing utilization review services for issuing denials of coverage. There are no financial incentives for UM staff or independent medical consultants to encourage utilization review decisions that result in under-utilization.
If you have any questions regarding utilization review,
After business hours, UM staff can receive secure voicemail, fax, and email. UM staff will respond to messages the next business day. If the message is received after midnight Monday through Friday, the staff will respond the same business day.
