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Level of Care Clinical Criteria
Note: The material provided are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.
ABH Affirmative Statement Regarding UM Decisions
1. UM decision making is based only on appropriateness of care and service and existence of coverage.
2. Access Behavioral Health does not specifically reward practitioners or other individuals for issuing denials of coverage or care.
3. Access Behavioral Health does not use financial incentives for UM decision makers to encourage decisions that result in underutilization.