Workers Compensation Utilization Management, v. 5.0
The following is a series of basic lessons, management tips, and hints on the URAC accreditation process regarding URAC's Workers Compensation Utilization Management (WCUM) accreditation module, v. 5.0.
- WCUM - 1 - Review Criteria Requirements
- WCUM - 2 - Access to Review Staff
- WCUM - 3 - Review Service Communication and Time Frames
- WCUM - 4 - Review Service Disclosures
- WCUM - 5 - On-Site Review Requirements
- WCUM - 6 - Initiation of Review Process
- WCUM - 7 - Limitations in Use of Non-Clinical Staff
- WCUM - 8 - Pre-Review Screening Staff Oversight
- WCUM - 9 - Pre-Review Screening Non-Certifications
- WCUM - 10 - Initial Clinical Reviewer Qualifications
- WCUM - 11 - Initial Clinical Reviewer Resources
- WCUM - 12 - Initial Clinical Reviewer Non-Certifications
- WCUM - 13 - Peer Clinical Review Cases
- WCUM - 14 - Peer Clinical Reviewer Qualifications
- WCUM - 15 - Peer-to-Peer Conversation Availability
- WCUM - 16 - Peer-to-Peer Conversation Alternate
- WCUM - 17 - Prospective Review Time Frames
- WCUM - 18 - Retrospective Review Time Frames
- WCUM - 19 - Concurrent Review Time Frames
- WCUM - 20 - Certification Decision Notice and Tracking
- WCUM - 21 - Continued Certification Decision Requirements
- WCUM - 22 - Written Notice of Non-Certification Decisions & Rationale
- WCUM - 23 - Clinical Rationale for Non-Certification Requirements
- WCUM - 24 - Reversal of Certification Determinations
- WCUM - 25 - Frequency of Continued Reviews
- WCUM - 26 - Scope of Review Information
- WCUM - 27 - Prospective and Concurrent Review Determinations
- WCUM - 28 - Retrospective Review Determinations
- WCUM - 29 - Lack of Information Policy and Procedures
- WCUM - 30 - Non-Certification Appeals Process
- WCUM - 31 - Appeal Process
- WCUM - 32 - Appeal Peer Reviewer Qualifications
- WCUM - 33 - Expedited Appeals Process Time Frame
- WCUM - 34 - Standard Appeals Process Time Frame
- WCUM - 35 - Written Notification of Upheld Non-Certifications
- WCUM - 36 - Appeal Record Documentation
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Workers Compensation Utilization Management, v. 5.0
- WCUM - 1 - Review Criteria Requirements
- WCUM - 2 - Access to Review Staff
- WCUM - 3 - Review Service Communication and Time Frames
- WCUM - 4 - Review Service Disclosures
- WCUM - 5 - On-Site Review Requirements
- WCUM - 6 - Initiation of Review Process
- WCUM - 7 - Limitations in Use of Non-Clinical Staff
- WCUM - 8 - Pre-Review Screening Staff Oversight
- WCUM - 9 - Pre-Review Screening Non-Certifications
- WCUM - 10 - Initial Clinical Reviewer Qualifications
- WCUM - 11 - Initial Clinical Reviewer Resources
- WCUM - 12 - Initial Clinical Reviewer Non-Certifications
- WCUM - 13 - Peer Clinical Review Cases
- WCUM - 14 - Peer Clinical Reviewer Qualifications
- WCUM - 15 - Peer-to-Peer Conversation Availability
- WCUM - 16 - Peer-to-Peer Conversation Alternate
- WCUM - 17 - Prospective Review Time Frames
- WCUM - 18 - Retrospective Review Time Frames
- WCUM - 19 - Concurrent Review Time Frames
- WCUM - 20 - Certification Decision Notice and Tracking
- WCUM - 21 - Continued Certification Decision Requirements
- WCUM - 22 - Written Notice of Non-Certification Decisions & Rationale
- WCUM - 23 - Clinical Rationale for Non-Certification Requirements
- WCUM - 24 - Reversal of Certification Determinations
- WCUM - 25 - Frequency of Continued Reviews
- WCUM - 26 - Scope of Review Information
- WCUM - 27 - Prospective and Concurrent Review Determinations
- WCUM - 28 - Retrospective Review Determinations
- WCUM - 29 - Lack of Information Policy and Procedures
- WCUM - 30 - Non-Certification Appeals Process
- WCUM - 31 - Appeal Process
- WCUM - 32 - Appeal Peer Reviewer Qualifications
- WCUM - 33 - Expedited Appeals Process Time Frame
- WCUM - 34 - Standard Appeals Process Time Frame
- WCUM - 35 - Written Notification of Upheld Non-Certifications
- WCUM - 36 - Appeal Record Documentation
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