In Utilization Management, "decisioning an appeal" refers to the process of reviewing the outcome of a request to reconsider a previous decision regarding healthcare services. This often involves evaluating the medical necessity, coverage policies, and any new information provided to overturn or uphold the initial decision.

* Access to Utilization Management * Permission to edit requests * Permission to view appeals * Permission to decision an appeal

When all information has been gathered for the appeal process and a decision can be made after review.

* Ensure Initial Review is complete * Ensure Information and Documentation are sufficient * Ensure any specialized reviews are complete

Start from the request view

Navigate to the **Services** section

Review the Initial, Outcome and Appeal

Click **Select Appeal Status** dropdown

### Add an Outcome to the Appeal* Adjust **Duration**, **From Date**, or **Units** if necessary. * Select **Status** * Select **Status Reason**

### Add a Request Outcome SummaryDepending on the adjusted outcome on the service, a rationale needs to be entered.* Navigate to the **Request Outcome Summaries** * Enter Rationale in the text box associated with the appeal._Note:_ Rationale is not required for an approved outcome.

Click **Submit and Save Review**

_(Alternate)_ Click **Save** to save the changes and stay on the request view to make additional changes.

_(Alternate)_ Click **Cancel** to leave the request view and discard any changes.{% include "https://app.gitbook.com/s/pBCMecbzmm4vQGE6p7FG/~/reusable/QXipU6WCHzGr5ORKhmgY/" %}