FAQ Directory: Utilization Management, Credentialing and Provider Network

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4.15.2016 Off-label medication use denials in UM 4H Are denials for “off-label” medication use included in the file review for UM 4, Element H (UM 4F in UM-CR and MBHO)?

Yes. Denials for off-label medication use are included in the scope of UM 4, Element H (UM 4F in UM-CR and MBHO) if the organization covers medications only for “on-label” use.

UM_CR 2016