Quality Management Information for Members
Incentives
Quest authorizes services based only on appropriateness of care and service and existence of coverage. Staff members, practitioners or other individuals do not receive rewards for issuing denials of coverage or service care. Financial incentives for UM decision makers do not encourage decisions that result in underutilization or offer incentives to reduce care and services. Staff members, practitioners, or other individuals are not encouraged in any way to authorize lower levels of care or fewer services. Staff members, practitioners or other individuals do not have any barriers that keep them from authorizing necessary care.
