URAC UM 34 -- v. 5.1 revision

The v. 5.1 upgrade to UM 34 is a partner to the revision to UM 33 (see blog on that standard here).  Like the UM 33 revision, this is billed as a "clarification of intent" standard.  Also like the UM 33 revision, it is a significant clarification.

The 5.0 version read:

Standard appeals are completed, and written notification of the appeal decision issued, within 30 calendar days of the receipt of the request for appeal. (Primary)

The question not answered by this standard was "to whom does the notification go?"  But then, one would have thought that UM 35 answered the question.  That standard reads, in relevant part:

For appeals determinations, the organization issues written notification of the adverse appeal decision to the patient and attending physician or other ordering provider or facility rendering service . . ..

But this deals only with affirmations of non-certifications -- what about the appeals that overturn the "non-certs"?  

URAC sorts it all out in the v. 5.1 UM 34:

Standard appeals are completed, and written notification of the appeal decision issued, within 30 calendar days of the receipt of the request for appeal to the patient and attending physician or other ordering provider or facility rendering service. (Primary)

In other words, the written notice of the appeal decision, no matter which way the decision goes, must be sent to both the patient and the provider.