Description

Covers the content of the UM program, Must Pass Elements, Critical Factors, inter-rater reliability of UM decisions, rules on denial decisions, pharmacy management and annual UM Program Evaluation. Excludes denial files, appeal files, system controls, and delegation of UM.

Learning Objectives:

• Review the Must Pass Elements and Critical Factors for UM.
• Identify the requirements for a UM Program Description and an Annual Evaluation of the UM Program.
• Explain the inter-rater reliability of individuals applying clinical criteria to UM decisions.
• Discuss the rules and language surrounding denials and appeals.
• Explain general requirements for UM Pharmacy Management and distinguish between medical and retail pharmacy benefits requirements.

Length: 2 Hours

Price:

List Price for Non MHR Clients: $5,000

MHR Clients: [20% discount off List Price] $4,000