FAQ Directory: Utilization Management, Credentialing and Provider Network

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1.15.2015 Permitting practitioner’s review of UM denials with administrative licenses May practitioners with a current administrative license review denials of care based on medical necessity?

Yes. NCQA allows practitioners with a current administrative license to review denials of care based on medical necessity if the state issues administrative licenses that permit review of UM medical necessity cases.

This applies to the following Programs and Years:
UM-CR 2013