Standard Year: 2025

Description: A guide on what an organization can expect when MHR conducts a file audit, including goals, expectations of MHR and from the organizations, the focus of file audits, best practices, universe, sampling, and methodology.

Type: File Review Guide

# of Pages: 11 pages

Cost: FREE for MHR Clients Only

Standards: CR 3 & 4

Standard Year: 2025

Description: Outline for documenting the evidence that should be used when building Credentialing and Recredentialing Files.  The directions for CR are applicable to both File Review Templates.    

Type: File Review Evidence Outline

# of Pages: NA

Cost: Free

MHR Clients Only

Standards: CR 3 & 4

Standard Year: 2025

Description: Guide used when completing CR and RR file reviews. Includes a table with columns that summarize the standards and confirm that each factor was met. Adds comments to consider such as differences between products.  

Type: File Review Guide

# of Pages: 3 pages

Cost: Free

MHR Clients Only

Standard: CR 3

Standard Year: 2025

Description: First Survey Template to bookmark CR-RR Practitioner File Reviews. Instructions are included with the purchase of the template. 

Type:  File Review Bookmark Template

# of Pages: 1 page with bookmark outline  

Cost: $1219 (MHR Client - $975)

 MHR Clients receive a 20% discount. 

Standards: CR3

Standard Year: 2025

Description: Instructions on building a First Survey practitioner credentialing file for review, including saving files, bookmarking, annotating, and labeling..

Type: File Review Prep Guide

# of Pages: 3 pages

Included with CR/RR Bookmark template purchase

Standard: CR 3 & 4

Standard Year: 2025

Description: Renewal Survey Template to bookmark CR-RR Practitioner File Reviews. Instructions are included with the purchase of the template. 

Type: File Review Bookmark Template

# of Pages: 1 page with bookmark outline

Included in CR/RR Bookmark Template Purchase

Standard: CR 3 & 4

Standard Year: 2025

Description: Instructions on building a Renewal Survey practitioner recredentialing file for review, including saving files, bookmarking, annotating, and labeling.

Type: File Review Prep Guide

# of Pages: 3 pages

Included in CR/RR Bookmark Template Review

Standard: CR 3 & 4

Standard Year: 2025

Description: Step-by-step instructions on how to create PDF documents for file reviews. It explains how to insert files into the PDF template and adjust bookmarks, use tools for annotating dates, and assemble the PDF documents to create an electronic binder for the presentation to NCQA. 

Type: File Review Prep Guide

# of Pages: 5 pages (same instructions across all file review types)

Included in CR/RR Bookmark Template Review

Standard: CR 3 & 4

Standard Year: 2025

Description: An expanded Excel file for documenting the findings of individual credentialing files. Each factor is listed in column A. As the auditor scores the file, results are tabulated with a percentage of compliant/non-compliant. Priced by the number of individuals who will use any of the tools for internal audits and delegation oversight audits. Thereafter, an annual licensing fee applies as MHR updates worksheets annually.

Type: Audit Tool

# of Pages: Instructions, Summary Results, Individual Results for 1-10 files

Cost: Varies by the number of users. Click here to learn more. 

MHR Clients receive a 20% discount. 

Standard: PHM 5D-E

Standard Year: 2025

Description: General instructions for CCM PHM 5D & E file reviews. Includes tables to document assessment findings by factor.   

Type: File Review Guide

# of Pages: 7 worksheets

Cost: FREE for MHR clients only. 

Standard: PHM 5D-E

Standard Year: 2025

Description: Template to bookmark file reviews for PHM 5D & E. Instructions are included with the purchase of the template. 

Type: File Review Bookmark Template

# of Pages: 1pg with bookmark outline

Cost: $1,219 (MHR Client - $975)

MHR Clients receive a 20% discount. 

Standard: PHM 5D-E

Standard Year: 2025

Description: Instructions for entering data used to assess the population health strategy impact. Includes examples and prompts for entering text to create a report.

Type: File Review Prep Guide

# of Pages: 8 pages

Included with PHM 5D-E (CCM) bookmark template purchase

Standard: PHM 5D-E

Standard Year: 2025

Description: Step-by-step instructions on how to create PDF documents for file reviews. It explains how to insert files into the PDF template and adjust bookmarks, use tools for annotating dates, and assemble the PDF documents to create an electronic binder for the presentation to NCQA. 

Type: File Review Prep Guide

# of Pages: 5 pages
*Same instructions across all file review types

 Included with PHM 5D-E (CCM) bookmark template purchase

Standard: PHM 5D-E

Standard Year: 2025

Description: An expanded Excel file for documenting NCQA audit findings of individual case management files. Each factor is listed in a row across with space to add individual file numbers. As the auditor scores the file, results are tabulated with a percentage of compliant/non-compliant. Priced by the number of individuals who will use any of the tools for internal audits and delegation oversight audits. Thereafter, an annual licensing fee applies as MHR updates worksheets annually. Includes instructions on creating PDF reports to send to delegates.

Type: Audit Tool

# of Pages: N/A

Cost: Varies by the number of users. Click here to learn more. 

MHR Clients receive a 20% discount. 

Standard: CM 2E & CM 4B

Standard Year: 2025

Description: Instructions for completing file reviews for CM 2E, timeliness of assessment, and 4B, Case Management ongoing management. Includes tables to document assessment findings by factor. 

Type: File Review Prep Guide

# of Pages: 12 pages

Cost: Free

MHR Clients Only

Standard: CM 7E

Standard Year: 2024, 2025

Description: An expanded Excel file for documenting the findings of individual case management credentialing files. Each factor is listed in a row across with space to add individual file numbers. As the auditor scores the file, results are tabulated with a percentage of compliant/non-compliant. Priced by the number of individuals who will use any of the tools for internal audits and delegation oversight audits. Thereafter, an annual licensing fee applies as MHR updates worksheets annually.

Type: Audit Tool

# of Pages: Instructions, Summary Results for up to 40 files

Cost: Varies by the number of users. Click here to learn more. 

MHR Clients receive a 20% discount. 

Standards: UM 4-7

Standard Year: 2025

Description: Guide used when completing UM file reviews. Includes a table with columns that summarize the standards and confirm that each factor was met. Adds comments to consider such as updates from PCS questions or other helpful hints. *In Development.

Type: File Review Guide

# of Pages: 7 pages

Cost: Free

MHR Clients Only

Standards: UM 4-7

Standard Year: 2025

Description: Three Denial File Review Bookmark Templates (Rx, NonBH, and BH).  Purchase includes Instructions for each. 

Type: File Review Bookmark Template

# of Pages: 1page with bookmark outline

Cost: $1,219 (MHR Client - $975)

MHR Clients receive a 20% discount. 

Standards: UM 4-7

Standard Year: 2025

Description: Three documents guide the user through building denial files in PDF format for each Rx, Non-BH, and BH file. The templates follow the standards and list what information to bookmark, such as dates, type of file, service requests, letters, criteria, and appeal rights.  Use with bookmark templates. 

Type: File Review Prep Guide

# of Pages: 14 pages

Included with UM 4 - 7 bookmark template purchase

Standards: UM 4-7

Standard Year: 2025

Description: This guide provides step-by-step instructions on how to create PDF documents for file reviews. It explains how to insert files into the PDF template and adjust bookmarks, use tools for annotating dates, and assemble the PDF documents to create an electronic binder for the presentation to NCQA. 

Type: File Review Prep Guide

# of Pages: 5 pages
*Same instructions across all file review types

Included with UM 4 - 7 bookmark template purchase

Standards: UM 4-7

Standard Year: 2025

Description: Four separate files are included for the UM 4-7 denial file review audit: non-BH & BH Medicaid & Medicare; non-BH & BH Commercial & Exchange; Rx Medicare; and Rx Medicaid. Each file contains worksheets for instructions, individual file audits, and a summary worksheet that calculates results.

Type:  Audit Tool

# of Pages: Instructions, Summary Results, Individual Results for 1-10 Files. 

Cost: Varies by the number of users. Click here to learn more. 

MHR Clients receive a 20% discount. 

Standards: UM 9

Standard Year: 2025

Description: Guide used when completing UM appeal file reviews. Includes a table with columns that summarize the standards and confirm that each factor was met. Adds comments to consider such as updates from PCS questions or other helpful hints. *In Development

Type: File Review Guide

# of Pages: 8 pages

Cost: FREE

MHR Clients Only

Standard: UM 9

Standard Year: 2025

Description: Template to bookmark UM 9 appeal file reviews.  Instructions are included with the purchase of the template. 

Type: File Review Bookmark Template

# of Pages: 1 page with bookmark outline

Cost: $1,219 (MHR Client - $975)

MHR Clients receive a 20% discount. 

Standards: UM 9

Standard Year: 2025 

Description: Instructions on how to build the UM appeal file. Includes adding records, labeling the bookmark, and adding text boxes with recommendations on how on to display information for ease of review by the NCQA Surveyor. 

Type: File Review Prep Guide

# of Pages: 5 pages

Included with UM 9 bookmark template purchase.

Standards: UM 9

Standard Year: 2025

Description: This guide provides step-by-step instructions on how to create PDF documents for file reviews. It explains how to insert files into the PDF template and adjust bookmarks, use tools for annotating dates, and assemble the PDF documents to create an electronic binder for the presentation to NCQA. 

Type: File Review Prep Guide

# of Pages: 5 pages
*Same instructions across all file review types

Included with UM 9 bookmark template purchase.

Standard: UM 9

Standard Year: 2025

Description: Three expanded Excel files (Commercial/Exchange, Medicaid, and Medicare) for documenting the findings of individual appeal files. Each worksheet lists factors for the product line. As the auditor scores the file, results are tabulated with a percentage of compliant/non-compliant. Priced by the number of individuals who will use any of the tools for internal audits and delegation oversight audits. Thereafter, an annual licensing fee applies as MHR updates worksheets annually.

Type: Audit Tool

# of Pages: Instructions, Summary Results, Individual Results for 1-10 files. 

Cost: Varies by the number of users. Click here to learn more. 

MHR Clients receive a 20% discount.