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Mercy Care would like to share that Utilization Management decision-making is based only on appropriateness of care and service, and existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for Utilization Management decision-makers do not encourage decisions that result in underutilization.
For more information on Utilization Management, please review our Mercy Care Provider Manual under Chapter 100 - Mercy Care General Terms, Chapter 11 - Utilization.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this Notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
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