Description

Covers the UM standards on appeals including appropriate handling of appeals, appropriate practitioner types to decide appeals, required documentation, denial letters, rationale for denials, and timeliness of reviews. Discusses the use of member-friendly language in notifications. Includes files included and excluded from review, insights from Policy Clarification Support (PCS) questions and FAQs. Emphasizes Must-Pass Elements.

Learning Objectives:

• Describe appropriate practitioner types who can make decisions for appeals.
• Specify appropriate documentation and rationale for appeal decisions.
• Explain how to write an appropriate rationale in denial letters.
• Recognize member-friendly language in notifications and when revisions are necessary.
• State timeframes for making decisions and reasons for extending appeal timeframes.
• Identify files to be included and excluded in the appeal file universe.

Length: 2 Hours

Price:

List Price for Non MHR Clients: $5,000

MHR Clients: [20% discount off List Price] $4,000