Practice Quiz

Managed Care Nursing

Category - Healthcare Management

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Which of the following is incorrect regarding NCQA clinical criteria for utilization management decisions?
  1. Approval and denial criteria are based on clinical and evidence-based practice.
  2. Health care providers are a part of the development of standard criteria.
  3. Criteria review, updates, and changes occur on accreditation cycle.
  4. Evaluation of the application of standard criteria against practices is completed.
  5. None of the above
Explanation
Answer: C - The NCQA clinical criteria for utilization management decisions includes approval and denial criteria based on clinical and evidence-based practice, health care providers being a part of the development of standard criteria, evaluation of the application of standard criteria against practices, and an annual review to includes updates and changes that are not in sync with the accreditation cycle.
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