On behalf of its contracted IPAs, ProSource MSO, LLC. ensures that all utilization related decisions regarding member coverage and or services must be based on appropriateness of care, service, and existence of coverage. Also, these decisions may not be influenced by any financial reward or incentive. ProSource MSO, LLC. will not allow any reward or incentive that could discourage appropriate care. ProSource MSO, LLC. does not reward providers, employees, or other individuals for issuing denials of service or coverage. All denials must be based strictly upon a lack of medical appropriateness, benefit coverage, or eligibility. UM decisions for members must be based only on appropriateness of care and existence of coverage. The contracted IPAs do not specifically reward practitioners or other individuals (directly or indirectly) for issuing denials of coverage or service care: financial incentives for UM decision makers do not encourage decisions that result in underutilization. Practitioners are ensured independence and impartiality in making referral decisions that will not influence: hiring, compensation or financial gain, termination, promotion, and any other similar matters.
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