Utilization Management
Provider Type
- Physicians (does not apply to Cal MediConnect)
- Participating Physician Groups (PPG)
(does not apply to HSP)
- Hospitals
- Ancillary
This section describes Health Net's utilization management program and processes.
Select any subject below:
- Overview
- Affirmative Statement About Incentives
- Availability of Criteria
- Care Management
- Clinical Criteria for Medical Management Decision Making
- Continuity of Care
- Coverage Determination
- Health Risk Assessment
- Medical Data Management Reporting
- Medical Data Management System
- Medicare Certified Facilities
- Non-Delegated Medical Management
- Notification of Hospital Admissions
- Notification of Hospital Discharge Appeal Rights
- Out-of-Area Services
- Separation of Medical Decisions and Financial Concerns
- Termination of Provider Services
- Utilization Management Goal
- Utilization Management Program Components