UM Tools and Templates
UM Bundle
Includes all tools and templates in UM Templates and Tools, at a discounted price.
UM 1A - UM Program Description Guide
Guide for completing a comprehensive UM Program Description.
UM 1B-UM Program Evaluation Template
Analysis template and comprehensive roadmap for completing the Annual UM Evaluation.
UM 2C Consistency in Applying UM Criteria Template
Analysis template for evaluating the consistency in applying UM criteria (UM 2C). Provides explanations, examples, and data entry guidance.
UM 2C Data Methodology and Collection Guide
Guide used to assess the inter-rater reliability of UM decisions.
Out of Network Requests UM Triage
Presentation of how to triage medical necessity requests.
UM 11A-E Pharmacy Benefits: Retail & Medical (MD Administered)
Explains UM 11 A-E standards for pharmaceuticals covered under the retail and medical benefits.
UM Denial File Information Integrity Audit Analysis
Comprehensive analysis template and guidance that addresses the UM Denial Information Integrity audit requirements.
UM Appeal File Information Integrity Audit Analysis
Comprehensive analysis template and guidance that addresses the UM Appeals Information Integrity audit requirements.
UM Information Integrity Audit Tool
Complements the UM Information Integrity Audit and Analysis Template (Denial and Appeals).
UM Mail Service Delegation
MHR Resource of NCQA PCS questions and FAQs from 2021 - 2023 on mail service. Discusses delegation versus vendors.
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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)
