Affirmative statement: Utilization Management decision-making is based only on appropriateness of care and service, and existence of coverage. BadgerCare Plus - CCHP does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.
Network: Together with CCHP does not use quality measures, member experience measures or cost-related measures to select practitioners or hospitals. After several years of Marketplace experience, Together may begin utilizing these measures to select practitioners/hospitals.