UM Affirmation for HMO Illinois, BlueAdvantage HMO, Blue Precision HMO

At Chicago Health System, Oak West PPA, West Suburban PHO we affirm that:

    1. UM decisions are based on medical necessity, which includes appropriateness of care and services, and the existence of available benefits;
    2.  this organization does not specifically reward practitioners, health plan staff, or other individuals for issuing denials of coverage, care or service; and;
    3.  incentive programs are not utilized to encourage decisions that result in  under-utilization.

Chicago Health System, Oak West PPA, West Suburban PHO also affirms that there is no conflict of interest between the IPA and their UM decision makers.

See entire UM Affirmation for HMO Illinois, BlueAdvantage HMO, Blue Precision HMO memo here.