Yes. Data from UM delegates must be included in the UM denial and appeal rates reported for UM 1, Elements B-E (in Health Plan Accreditation). The intent of reporting the rates for these elements is to provide a comprehensive view of the organization’s UM denial and appeal rates. Therefore, the expectation is that the organization presents all rates in a single workbook, rather than separating requests received by the organization (e.g., health plan) and those received by the delegate.
Applicable standards:
- Health Plan Accreditation: UM 1, Elements B-E.
- Behavioral Health Accreditation: UM 1, Elements B-D.
- Utilization Management Accreditation: UM 3, Elements B-E.