UM / QM Programs

HN1’s objective is to ensure that utilization is appropriate, without evidence of over or under utilization, and that our activities measurably impact favorable health outcomes for the population we serve:

  • Network Medical Director for each single network specialty
  • Medical Advisory Committee
  • Provider Satisfaction Surveys
  • Clinical Outcome Studies
  • Chart Reviews
  • Toll-free numbers for members and physicians
  • Concurrent review of medical records, surgical outcome studies, and encounter reporting
  • Ongoing analyses of access & availability

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