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4.15.2026 Delegation oversight for UM Information Integrity for UM approval delegates Are UM Information Integrity oversight requirements for UM request receipt and notification dates scored Not Applicable (NA) for delegates that only perform approvals and recommendations?

UM Information Integrity oversight requirements related to UM request receipt and UM decision notification dates may be scored Not Applicable (NA) for delegates that only perform approvals and/or recommendations. Please note that this exception does not apply to delegates that make denial decisions.
Factors 5–7 are limited to the evaluation of UM receipt and notification dates.

Applicable standards:

  • Health Plan Accreditation: UM 12, Element C, factors 5–7
  • Utilization Management Accreditation: UM 8, Element C, factors 5–7
  • Behavioral Health Accreditation: UM 10, Element C, factors 5–7

This applies to the following Programs and Years:
HP 2026|UM 2026|BHA 2026