In accordance with the National Committee on Quality Assurance (NCQA) standards, MPMG employees who make utilization-related decisions, and those who supervise them, make these decisions based on appropriateness of care, service, and existence of coverage. MPMG does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service. In addition, there are no financial incentives for Utilization Management decision makers and MPMG does not encourage decisions that result in under utilization.

Last Reviewed:  January 2008