Health Utilization Management, v. 5.0/5.1
The following are best practices and other tips about URAC's Health Utilization Management accreditation module.
- Introduction to the Health Utilization Management Training Module
- URAC UM -- Mandatory Standards
- URAC UM 1 -- Review Criteria Requirements
- URAC UM 2 -- Access to Review Staff
- URAC UM 3 -- Review Service Communication Timeframes
- URAC UM 4 -- Review Service Disclosures
- URAC UM 5 -- Onsite Review Requirements
- URAC UM 7 -- Limitations in Use of Non-Clinical Staff
- URAC UM 8 -- Pre-Review Screening Staff Oversight
- URAC UM 9 -- Pre-Review Screening Non-Certifications
- URAC UM 10 -- Initial Clinical Reviewer Qualifications
- URAC UM 11 -- Initial Clinical Reviewer Resources
- URAC UM 12 -- Initial Clinical Reviewer Non-Certifications
- URAC UM 13 -- Peer Clinical Review Cases
- URAC UM 14 -- Peer Clinical Reviewer Qualifications
- URAC UM 15 -- Peer-to-Peer Conversation Availability
- URAC UM 16 -- Peer-to-Peer Conversation Alternate
- URAC UM 17 -- Prospective Review Time Frames
- URAC UM 18 -- Retrospective Review Timeframes
- URAC UM 19 -- Concurrent Review Timeframes
- URAC UM 20 -- Certification Decision Notice and Tracking
- URAC UM 21 -- Continued Certfication Decision Requirements
- URAC UM 22 -- Written Notice of Non-Certification Decisions and Rationale
- URAC UM 23 -- Clinical Rationale for Non-Certification Requirements
- URAC UM 24 -- Reversal of Certification Determinations
- URAC UM 25 -- Frequency of Continued Reviews
- URAC UM 26 -- Scope of Review Information
- URAC UM 27 -- Prospective and Concurrent Review Determinations
- URAC UM 28 -- Retrospective Review Determinations
- URAC UM 29 -- Lack of Information Policy and Procedure
- URAC UM 30 -- Non-Certification Appeals Process
- URAC UM 30-35 -- Are the providers' appeal rights independent, or based on the consumers' rights?
- URAC UM 31 -- Appeals Process
- URAC UM 32 -- Appeal Peer Reviewer Qualifications
- URAC UM 33 -- Expedited Appeals Process Timeframe
- URAC UM 34 -- Standard Appeals Process Timeframe
- URAC UM 35 -- Written Notice of Upheld Non-Certifications
- URAC UM 36 -- Appeal Record Documentation
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Health Utilization Management, v. 5.0/5.1
- Introduction to the Health Utilization Management Training Module
- URAC UM -- Mandatory Standards
- URAC UM 1 -- Review Criteria Requirements
- URAC UM 2 -- Access to Review Staff
- URAC UM 3 -- Review Service Communication Timeframes
- URAC UM 4 -- Review Service Disclosures
- URAC UM 5 -- Onsite Review Requirements
- URAC UM 7 -- Limitations in Use of Non-Clinical Staff
- URAC UM 8 -- Pre-Review Screening Staff Oversight
- URAC UM 9 -- Pre-Review Screening Non-Certifications
- URAC UM 10 -- Initial Clinical Reviewer Qualifications
- URAC UM 11 -- Initial Clinical Reviewer Resources
- URAC UM 12 -- Initial Clinical Reviewer Non-Certifications
- URAC UM 13 -- Peer Clinical Review Cases
- URAC UM 14 -- Peer Clinical Reviewer Qualifications
- URAC UM 15 -- Peer-to-Peer Conversation Availability
- URAC UM 16 -- Peer-to-Peer Conversation Alternate
- URAC UM 17 -- Prospective Review Time Frames
- URAC UM 18 -- Retrospective Review Timeframes
- URAC UM 19 -- Concurrent Review Timeframes
- URAC UM 20 -- Certification Decision Notice and Tracking
- URAC UM 21 -- Continued Certfication Decision Requirements
- URAC UM 22 -- Written Notice of Non-Certification Decisions and Rationale
- URAC UM 23 -- Clinical Rationale for Non-Certification Requirements
- URAC UM 24 -- Reversal of Certification Determinations
- URAC UM 25 -- Frequency of Continued Reviews
- URAC UM 26 -- Scope of Review Information
- URAC UM 27 -- Prospective and Concurrent Review Determinations
- URAC UM 28 -- Retrospective Review Determinations
- URAC UM 29 -- Lack of Information Policy and Procedure
- URAC UM 30 -- Non-Certification Appeals Process
- URAC UM 30-35 -- Are the providers' appeal rights independent, or based on the consumers' rights?
- URAC UM 31 -- Appeals Process
- URAC UM 32 -- Appeal Peer Reviewer Qualifications
- URAC UM 33 -- Expedited Appeals Process Timeframe
- URAC UM 34 -- Standard Appeals Process Timeframe
- URAC UM 35 -- Written Notice of Upheld Non-Certifications
- URAC UM 36 -- Appeal Record Documentation
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