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Is the UM appeal file review limited to first level appeal, or does it include all levels of appeals?

April 26, 2017appeal appeals file level levels limited review UM

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Is the UM appeal file review limited to first level appeal, or does it include all levels of appeals?

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Response: The scope of URAC’s medical necessity appeal process is limited to the first level of review as indicated by the definition (above) and standard HUM 31(c) (above); therefore, the file review for Health Utilization Management accreditation will be limited to the first level of review.