Are Utilization Management Decisions Financially Influenced?

October 22, 2019

Blue Cross and Blue Shield of New Mexico (BCBSNM) is dedicated to serving our customers through the provision of health care coverage and related benefit services. BCBSNM prohibits utilization management decisions based on financial incentives – those decisions are based on appropriateness of care and service and existence of coverage.

BCBSNM does not specifically reward practitioners or clinicians for issuing denials of coverage. Financial incentives for utilization management decision makers do not encourage decisions that result in underutilization.