In accordance with National Committee on Quality Assurance (NCQA) standards, Brown & Toland employees who make utilization-related decisions and those who supervise them make Utilization Management decisions based only on appropriateness of care and service. Also, Brown & Toland does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service. In addition, there are no financial incentives for Utilization Management decision makers and Brown & Toland does not encourage decisions that result in underutilization.

Compensation plans for individuals who provide utilization review services do not contain incentives, direct or indirect, for these individuals to make inappropriate review decisions.

Requests for clinical criteria including those requests for emerging and current technologies, devices, medical procedures, and techniques should be directed either in writing or by telephone to:

Brown & Toland Referral Services Department
P. O. Box 640469
San Francisco, CA 94164-0469
415.972.6025