MP CareSolutions is proud to be an NCQA-Accredited Utilization Management services organization.
MP CareSolutions makes decisions regarding the provision of healthcare services based solely on the appropriateness of care and services and the existence of coverage.
MP CareSolutions does not:
- Pay any employee, consultant, provider, or independent contractor any financial incentive to deny care
- Specifically reward practitioners or other individuals conducting utilization management review for issuing denials of coverage or of care
- Provide incentives for utilization management decision-makers that result in underutilization of appropriate services
The right care, at the right place, at the right time.
At MP CareSolutions, our expertise in Utilization Management helps ensure that individuals receive health services that are medically relevant and cost effective.
With our help, you can be confident that the right care is given at the right time, in the right place, by the right provider.
However, in some cases when services are denied, the member and provider have rights to an external appeal.
If a denial was issued because services were deemed not medically necessary, experimental or investigational, or out-of-network, the decision can be appealed to a NYS certified third party external appeal agent. To get an External Appeal application and instructions, call the New York State Department of Financial Services at 1-800-400-8882 or go on line at www.dfs.ny.gov