System Controls: Utilization Management & Credentialing

August 3, 2022

Cost: $249
Date: Wednesday, August 3, 2022; 2-4pm ET

System Controls: Utilization Management & Credentialing – NCQA Accreditation 2022

The System Controls requirements for Health Plan Accreditation aim to uphold the integrity of utilization management and credentialing systems and processes. Through this session, NCQA staff will address the new System Controls requirements for the 2022 Health Plan Accreditation Utilization Management and Credentialing Standards.

Course topics are not exclusive to NCQA requirements but are applicable to NCQA requirements for Health Plan Accreditation. Participants are expected to have a working knowledge of utilization management, credentialing, and policies and procedures for Health Plan Accreditation.

Key Topics
•    Credentialing
•    Denials and Appeals for Utilization Management
•    System Control Monitoring
•    System Control Oversight
•    Delegation and Automatic Credit

Benefits and Resources
•    Presentation Slides
•    Recording of Live Session
•    Live Q&A
•    Scenarios for Applied Learning
•    Perspective from Former NCQA Staff
 
 

Target Audience

  • Clinicians and staff at health plans.
  • Contributors of NCQA Surveys for Health Plan Accreditation.
  • Delegates and vendors of health plans.
  • Professional who led multidisciplinary teams.

Learning Objectives

•    Describe the intent of the System Controls Standards for Utilization Management and Credentialing.
•    Distinguish key differences between 2021 and 2022 System Controls Standards for Utilization Management and       Credentialing.
•    Summarize new requirements in the 2022 System Controls Standards for Utilization Management and Credentialing.
•    Analyze the new System Controls Oversight requirements for Utilization Management and Credentialing.
•    Explain the scope of delegation and automatic credit requirements.

Course summary
Available credit: 
  • 1.00 Participation
  • 4.00 PCMH CCE
Course opens: 
05/23/2022
Course expires: 
08/03/2023
Event starts: 
08/03/2022 - 2:00pm EDT
Event ends: 
08/03/2022 - 4:00pm EDT
Cost:
$249.00
Rating: 
0

Julie Pung

Gerald Stewart

Melina Bowdwin

Joy Park

This live course grants 4.0 Other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours.

Available Credit

  • 1.00 Participation
  • 4.00 PCMH CCE

Price

Cost:
$249.00
Please login or register to take this course.