FAQ Directory: Utilization Management, Credentialing and Provider Network

Filter Results
  • Save
  • Email
  • Print

You are viewing a single FAQ from your previous search. Clear Search

expand all

8.15.2025 UM Information Integrity Audit File Universe The denial and appeal Information Integrity audit universe specifies decisions (based on the notification date) made during the look-back period. Does the audit include data (decision notifications) from outside the look-back period?

Yes. When an organization conducts its UM Information Integrity audit, the audit universe includes data from the most recent 12 months from the timing of the audit. So, although the audit occurs within the look-back period, data reviewed may  include decision notification files from outside the formal look-back window, depending on timing. 

UM_CR 2026