Virginia Premier Health Plan, Inc.

Utilization Management

You can click to view and print the PDFs from the following list. To save these PDFs, right click on the link and choose "Save Target As..."

Primary Emergent Diagnosis Choose Not To Review List 081310

Utilization Management Program Description

Utilization Review

How to read PDF files

In order to download and view PDF files, you should download the free Adobe Acrobat Reader and install it on your computer.

Affirmative Statement About Incentives

Virginia Premier Health Plan, Inc. wants to assure its provider network and membership that all covered benefits are open to its members without regard to any financial gains from reduction in utilization.

Virginia Premier affirms the following regarding utilization management (UM) practices:

• UM decision-making is based only on appropriateness of care and services and the existence of coverage,
• Practitioners or other individuals are not rewarded for issuing denials of coverage or service of care, and
• UM decision makers do not receive financial incentives to encourage decisions that result in underutilization.

Please feel free to contact Virginia Premier's Medical Management or Compliance departments at (800) 727-7536 should you have questions regarding this practice.