UM & UMA Tools & Templates

UM & UMA Tools and Templates

Guide for completing a comprehensive UM Program Description.

Analysis template and comprehensive roadmap for completing the Annual UM Evaluation.

Analysis template for evaluating the consistency in applying UM criteria (UM 2C). Provides explanations, examples, and data entry guidance.

Guide used to assess the inter-rater reliability of UM decisions.

Presentation of how to triage medical necessity requests.

Explains UM 11 A-E standards for pharmaceuticals covered under the retail and medical benefits, and considerations to assess for compliance.

Comprehensive analysis template and guidance that addresses the UM Denial Information Integrity audit requirements.

Comprehensive analysis template and guidance that addresses the UM Appeals Information Integrity audit requirements.

Complements the UM Information Integrity Audit and Analysis Template (Denial and Appeals).

MHR Resource of NCQA PCS questions and FAQs from 2021 - 2023 on mail service. Discusses delegation versus vendors.

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