Denials File Review Training
Description
Covers the UM 4-7 standards on denials including appropriate professionals, timeliness of decisions, clinical information, appropriate rationale, denial notices, and the importance of using member-friendly language in notifications. Identifies files included and excluded from review, insights from Policy Clarification Support (PCS) questions, and FAQs. Emphasizes Must-Pass Elements.
Learning Objectives:
- Describe the requirements for appropriate professionals who can make decisions on denials for medical necessity, experimental and investigational treatments, and benefits.
- Specify appropriate clinical documentation, including the rationale for making a denial decision.
- Recognize the importance of using member-friendly language in notifications and when revisions are necessary.
- Identify appropriate reasons and timeframes for extensions of denial decisions.
- Identify the required language for the appeals process needed in the denial notification.
- Identify files to be included and excluded in the denial file universe.
Length: 2.5 - 3 Hours
Price:
List Price for Non MHR Clients: $5,000
MHR Clients: [20% discount off List Price] $4,000
UM Denial File Information Integrity Audit Analysis
Comprehensive analysis template and guidance that addresses the UM Denial Information Integrity audit requirements.
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