End of CPA 4.0 - Quality Performance Monitoring (CP 47-50)


You've finished this unit.

CP 50 - Performance Monitoring: Complaints and Communications


Basics

Your organization must generate quarterly reports regarding:

CP 49 - Database Tracking and Internal Monitoring: Individual Claims Processing


Basics

Under this standard, your organization's electronic claims database must monitor, for each claim, the following:

CP 48 - Performance Monitoring: Claims Processing


Basics

This standard requires quarterly reporting on performance measures related to timeliness of claims processing for internal and external claims adjudication and re-pricing.

CP 47 - Performance Monitoring and Maintenance


Basics

This standard requires that your organization implement performance monitoring and maintenance through the following means:

End of CPA 4.0 Timeliness


You've finished this unit.

CP 46 - Additional Information Policies and PRocedures


Basics

This standard covers the situation in which the claimant from whom you have asked for additional information does not get it to you within the 45-day time limit.

CP 45 - Extension of Time Frames


Basics

In those situations in which, under CP 44, your organization does extend time in order to get extra information from the claimant, the notice must specifically describe the needed in

CP 44 - Notification of Benefit Time Frames


Basics

This standard sets forth URAC's timeliness requirements for when you must notify claimants of your benefits determinations. You must notify claimants of such determinations:

CP 43 - Clean Claims Determination Time Frame


Basics

This standard requires that, if your organization fails to notify the claimant within the prescribed time frames, the claim must be considered a clean claim.