​Reducing costs. Improving outcomes. Ensuring fairness

Utilization management (UM) is more important than ever. By applying objective, evidence-based criteria, UM organizations evaluate health care service requests to make fair, timely, and clinically sound determinations.

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NCQA’s Utilization Management Accreditation

​provides a trusted framework that helps organizations implement best practices to:

• Conduct fair and timely evaluations using relevant clinical information.

• Ensure qualified health professionals review and determine requests.

• Maintain alignment with state requirements.​

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