UM Tools and Templates
UM standards explain how to evaluate and determine coverage for and appropriateness of medical care services. Includes criteria used to evaluate care and the ability to appeal denials of approval.
UM Bundle
UM 1A - UM Program Description Guide
UM 1B - UM Program Evaluation Template
UM 2C Consistency in Applying UM Criteria Template
UM 2C Data Methodology and Collection Guide
Out of Network Requests UM Triage
UM 11A-E Pharmacy Benefits: Retail & Medical (MD Administered)
UM Denial File Information Integrity Audit Analysis
UM Appeal File Information Integrity Audit Analysis
UM Information Integrity Audit Tool
UM Mail Service Delegation
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