Managed Healthcare Resources NCQA Tools & Templates – File Review
MHR’s tools and templates for File Review help healthcare organizations ensure compliance across multiple NCQA standards. File reviews audit performance against standards on complex case management, credentialing, recredentialing, utilization management denials, and utilization management appeals. MHR's tools and templates promote consistent, thorough, accurate, and compliant performance throughout the NCQA accreditation process.
MHR File Review Overview
A guide on what an organization can expect when MHR conducts a file audit.
CR & RR File Review
File Review Evidence Preparation Outline
Outlines documentation of evidence that should be used when building Credentialing and Recredentialing Files.
CR File Review Bookmark Template - First Survey
First Survey Template to bookmark CR-RR Practitioner File Reviews. Instructions are included with the purchase of the template.
CR File Review Instructions - First Survey
Instructions on building a First Survey practitioner credentialing file for review, including saving files, bookmarking, annotating, and labeling.
CR RR File Review Instructions - Renewal Survey
Instructions on building a Renewal Survey practitioner recredentialing file for review, including saving files, bookmarking, annotating, and labeling.
CR-RR File PDF Setup Instructions
Step-by-step instructions on how to create PDF documents for file reviews.
CR 3-4 MHR Cred-Recred Audit Tool
An expanded Excel file for documenting NCQA audit findings of individual credentialing and recredentialing files.
CR RR File Review Bookmark Template-Renewal Survey
Renewal Survey Template to bookmark CR-RR Practitioner File Reviews. Instructions are included with the purchase of the template.
CRA & CRC Cred-Recred Audit Tools
An expanded Excel file for documenting NCQA audit findings of individual credentialing and recredentialing files.
CCM (HP PHM 5) & CM Accreditation File Review
CCM PHM 5D & E File Review Guide
General instructions for CCM PHM 5D & E file reviews. Includes tables to document assessment findings by factor.
PHM 5D File Review Bookmark Template
Template to bookmark file reviews for PHM 5D & E. Instructions are included with the purchase of the template.
PHM 5 D E File Review Instructions
Instructions for entering data used to assess the population health strategy impact.
PHM 5 D E File PDF Setup Instructions
Step-by-step instructions on how to create PDF documents for file reviews.
PHM 5D-E MHR CCM Audit Tool
An expanded Excel file for documenting NCQA audit findings of individual case management files.
CM 2E and 4B Accreditation File Review Guide
Instructions for completing file reviews for CM 2E, timeliness of assessment, and 4B, Case Management ongoing management.
CM 7E MHR Credentialing Audit Tool
An expanded Excel file for documenting NCQA audit findings of individual case management credentialing files.
UM Denial File Review
UM Medical Necessity Denial File Review Guide
Use this guide when completing UM file reviews.
UM 4-7 File Review Bookmark Template- Rx - NonBH - BH
Three Denial File Review Bookmark Templates (Rx, NonBH, and BH). Purchase includes Instructions for each.
UM 4-7 Denial File Bookmark Template Instructions - Rx
- NonBH - BH
Three documents guide the user through building denial files in PDF format for each Rx, Non-BH, and BH file. Use with bookmark templates.
UM 4-7 File PDF Setup Instructions
Provides step-by-step instructions on how to create PDF documents for file reviews.
UM 4-7 Denial File Audit Tools
Four files are included for the UM 4-7 denial file review audit. Each file contains worksheets for instructions, individual file audits, and a summary worksheet that calculates results.
UM - Appeal File Review
UM 9 Appeal File Review Bookmark Template
Template to bookmark UM 9 appeal file reviews. Instructions are included with the purchase of the template.
UM 9 Appeal File Review Instructions - 2024
Instructions on how to build the UM appeal file for ease of review by the NCQA Surveyor.
Appeal File PDF Setup Instructions - 2024
Provides step-by-step instructions on how to create PDF documents for file reviews.
UM 9 MHR Appeal Audit Tool
Three expanded Excel files (Commercial/Exchange, Medicaid, and Medicare) for documenting NCQA audit findings of individual appeal files.
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You May Also Be Interested in Related Tools & Templates
Appeal File Review Training
Denials File Review Training
Quick Links - MHR Tools and Templates
Select the desired scope area(s) below to see all Tools and Templates available.
- Across Standards
- Credentialing & Recredentialing (CR/RR)
- Delegation
- File Review Tools & Guides
- Gap Assessments (Included with MHR Consulting)
- Health Equity (HE)
- Long-term Services and Supports (LTSS)
- Member Experience (ME)
- Model of Care (MOC)
- Network Management (NET)
- Population Health Management (PHM)/Population Health Program (PHP)
- Quality Improvement (QI)
- Successful Survey
- Utilization Management (UM)
