NHP's Affirmative Statement

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NHP’s Medical Management Department is sensitive to and understands that under- utilization of health care and services is as critical an issue and may pose a risk to the health and safety of members. Underutilization may result in lack of preventive care, inadequate access to outpatient and inpatient care and inappropriate emergency room use.

NHP monitors the utilization practices of its practitioners and providers to detect and correct potential underutilization.

NHP does not use incentives to encourage barriers to care and/or service, or to reward inappropriate restrictions of care. Rather NHP encourages appropriate utilization and discourages underutilization.

NHP distributes to all practitioners, providers and members, a statement describing the basis for NHP’s utilization management decision making. NHP affirms that:

• Utilization management decision making is based only on appropriateness of care and services and existence of coverage,

• NHP does not reward practitioners or other individuals conducting utilization review for issuing denials of coverage of service or care,

• No incentives are offered to encourage underutilization.

It is important to NHP that you understand our commitment to ensuring that our members receive the best and most appropriate care possible.