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Blue Cross’ utilization management (UM) decision-making is based only on appropriateness of care and services and the existence of coverage. Blue Cross does not make decisions about hiring, promoting or terminating practitioners or other staff based on the likelihood, or on the perceived likelihood, that the practitioner or staff member supports, or tends to support, denial of benefits.

Blue Cross does not in any way reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision-makers are designed to promote consistent and appropriate determinations resulting in evidence-based care. Blue Cross does not encourage decisions that result in underutilization or barriers to care/services.