Safeguard in Utilization
Paramount's utilization management decisions are based
only on appropriateness of care and service and the
existence of coverage. Utilization management staff and
associate medical/clinical directors are not financially or
otherwise paid to encourage underutilization and/or
denials of coverage or care.
In fact, Paramount monitors and analyzes monthly
reports for patterns of underutilization and takes action to
address any identified problems. In addition, nursing staff
cannot deny services—denials can be made only by board
certified, locally participating physicians.