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6.15.2026 Communication to Practitioners About Availability of UM Criteria The scope of review under UM 4, Element B: Availability of UM Criteria in UM Accreditation and Behavioral Health Accreditation (BHA) states that NCQA reviews the organization’s electronic communication of criteria availability to each practitioner. This same language does not appear in the corresponding requirement in Health Plan Accreditation (HPA). Will NCQA review electronic communication to practitioners regarding the availability of UM criteria under UM 4, Element B in UM Accreditation and BHA?

No. To align with HPA, NCQA does not review communication to practitioners about the availability of UM criteria in UM 4, Element B in UM Accreditation or BHA. Instead, NCQA evaluates whether the organization makes the criteria available electronically (e.g., through an EHR, portal, or website). Acceptable evidence includes system reports or screenshots demonstrating how practitioners access the criteria at the point of care.

Applicable standards:

  • Utilization Management Accreditation – UM 4, Element B
  • Behavioral Health Accreditation – UM 2, Element B

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