Utilization management decisions are based only on appropriateness of care and do not include incentives or reward practitioners to encourage underutilization or denials of coverage. Hennepin Health will distribute and document its affirmative statement through the web or in an alternative form such as writing, fax or mailing when requested. Mechanisms for distribution will include one or more of the following: member services handbook, mailing to members, newsletter article, practitioner handbook, published on the internet and/or a focused mailing. The statements will be updated and reviewed annually.
Members have the right to an independent review regarding any utilization management decisions.
In accordance with the Minnesota Patient Protection Act, certain health services provided under the direction of your physician require prior Hennepin Health approval, including:
Also in accordance with the Minnesota Patient Protection Act, you have the right to request a standing referral – written consent allowing you to see a specialist (for a chronic condition) more than once without having to get a new referral from your primary care clinic each time. A standing referral must be from your primary clinic, and state in writing all services to be provided and for how long. The specialist is not able to make additional referrals for services without permission from your primary care clinic.
Certain services require prior authorization (PA) for Hennepin Health members. The list of services requiring prior authorization is not all-inclusive and may be updated at any time. Providers are responsible for verifying eligibility and benefits before providing services to members.
If you have any questions regarding the above information, call Hennepin Health Member Services at 612-596-1036 (TTY: 1-800-627-3529), Monday through Friday from 8 a.m. to 4:30 p.m. For after-hour requests, a message can be left on the confidential voice mail and your call will be returned the following business day. Upon request, this information can be made available in an alternative format such as Braille, large print or audiotape.