Non-Incentive Programs

PerformCare does not provide incentives to employees who conduct utilization management (UM) activities for denying, limiting, or discontinuing medically necessary services.

• UM decision-making is based only on appropriateness of care and service and existence of coverage.
• PerformCare does not specifically reward providers or other individuals for issuing denials of coverage or service care.
• Financial incentives for UM decision-makers do not encourage decisions that result in under-utilization.