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FAQ Directory: Utilization Management, Credentialing and Provider Network

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5.15.2022 System Controls Goal for Analysis Is a goal required for system controls monitoring analysis for UM 12, Elements B and D, factor 2 and CR 1, Element D, factor 2?

No. Although the organization may set a monitoring goal, NCQA does not require it for UM 12, Elements B and D, factor 2 and CR 1, Element D, factor 2. The intent is that the organization reviews all instances of modifications that did not meet its policies and procedures.

UM_CR 2022