Key Contact Information
Claims questions: 1-800-880-1188
Contract questions: 1-877-633-4701
Catamaran Pharmacy Help Desk: 1-800-880-1188
Financial Incentives
Catamaran Affirmative Statement Concerning Incentives with Utilization Management (UM) Decisions
Catamaran is committed to encouraging appropriate utilization of pharmacy benefit management (PBM) services and the avoidance of underutilization. Underutilization of care and services carries significant risks to the well-being of members such as possible inappropriate and/or delayed treatment, preventable contraction of disease, extended duration and/or exacerbation of symptoms, undetected progression of disease, misdiagnosis, lowered quality of life, permanent loss of function and preventable death. Practitioners, pharmacies, consultants, committee members and staff who make utilization-related decisions need to exercise special care when performing their responsibilities related to Utilization Management. Catamaran does not use any incentives to encourage barriers to PBM services by ensuring the following:
- The Catamaran UM decision-making process is based only on the appropriateness of care and service and the existence of coverage.
- Catamaran does not specifically reward practitioners or other individuals for issuing denials of coverage.
- Financial incentives for Catamaran UM decision makers do not encourage decisions that result in underutilization.