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Availability of Criteria

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Health Net affirms that utilization management decision making is based on appropriateness of care and service, and the existence of coverage. Health Net does not reward practitioners or other individuals for issuing denials of service or care. There are no financial incentives to deny care or encourage decisions that result in underutilization. 

Last Updated: 10/31/2019