FAQ Directory: Utilization Management, Credentialing and Provider Network

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1.15.2025 Reviewer Names on Denial and Appeal Notifications (MBHO & UM) Does NCQA require names or signatures of the reviewers on UM denial and appeal notifications?

No. NCQA does not require names or signatures of the reviewers on UM denial and appeal notifications. Please refer to UM 4, Element C and UM 9, Element D for documentation requirements. 

This applies to the following Programs and Years:
MBHO 2025|UM-CR-PN 2025