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FAQ Directory: Utilization Management, Credentialing and Provider Network

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10.15.2013 Meeting UM 7C and 7F using the Notice of Denial of Medical Prescription Drug Coverage. Does the Notice of Denial of Medicare Prescription Drug Coverage meet the same factors in UM 7, Elements C and F as the Notice of Denial of Medical Coverage (NDMC)?

Yes. NCQA accepts the Notice of Denial of Medical Prescription Drug Coverage as meeting factors 1-3 of these elements.

UM_CR 2013