FAQ Directory: Health Plan Accreditation

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10.15.2016 UM 7 Denial Notification Under UM 7, Element A, may organizations use a mass communication to notify treating practitioners of the opportunity to discuss a denial?

No. Organizations may not use mass communication for this element. Organizations have three options to notify practitioners of the opportunity to discuss a denial:
1. In the denial notification (included in the denial file).
2. By telephone (time and date of the denial included in the denial file).
3. In materials sent to the treating practitioner, informing the practitioner of the opportunity to discuss a specific denial with a reviewer (evidence that the practitioner was notified that a physician or other reviewer is available to discuss the denial included in the denial file).
 

HP 2017