Peach State Health Plan does not reward or pay its group of providers, or employees for completing medical use reviews. They do not pay its group of providers or employees to deny reviews. Use decisions are based on the following reasons:
• Services are medically needed
• Services are covered in the member’s plan
Our systems allow us and our partners to:
• And monitor the care given
This process ensures that you (member) receive the right healthcare.
We care about your health and want you to get better. We use certain methods to make sure that you receive the best healthcare for your condition. Those processes are listed below:
• Watch for under and over use of services – best course of action is
taken if this occurs
• A system in place to support the study of medical use measurements
• Detect possible quality of care issues
• Put into action intervention plans
• And measures the success of the actions taken
• A process to support stability of care across the health care field
If you need help understanding this information, call the Member Services department at 1-800-704-1484 or TDD/TYY 1-800-255-0056.