UM Tools and Templates

UM standards explain how to evaluate and determine coverage for and appropriateness of medical care services. Includes criteria used to evaluate care and the ability to appeal denials of approval.

UM 1A - UM Program Description Guide

UM 1B - UM Program Evaluation Template

UM 2C Consistency in Applying UM Criteria Template

UM 2C Data Methodology and Collection Guide

Out of Network Requests UM Triage

UM 11A-E Pharmacy Benefits: Retail & Medical (MD Administered)

UM 12B & 12D Monitoring Report for UM System Controls Template

UM Mail Service Delegation

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MHR Tools and Templates