CAPNET is an independent physician network of more than 300 primary care physicians and specialists with established practices.
These well-respected, highly skilled doctors remain dedicated to helping and healing those who are ill, and maintaining the good health of the communities served.
Closely affiliated with local hospitals, CAPNET has implemented express referral programs in certain specialties for plan members to access care, without delay of prior authorization, thereby ensuring that the finest professionals and cost-effective care is
Utilization Management decisions are made utilizing adopted nationally recognized criteria, along with other criteria developed by CAPNET IPA. This information can be made available to you (the member) simply by contacting CAPNET IPA Utilization Management Department.
CAPNET IPA requires that all participating providers and staff who make utilization management decisions and those who supervise them sign a document affirming that a utilization management decision is based solely on the appropriateness of a given treatment and service, as well as the existence of coverage. The statements are kept on file at CAPNET for patient review. CAPNET does not specifically reward participating providers or other individuals conducting utilization management review for issuing denials of coverage. There are no financial incentives for utilization management decision makers that will encourage decisions that result in either the denial or modification of medically necessary covered services.