UMR Responses

Review UMR's responses to GEHA disagrees and random audit feedback

Response Type
UMR Response
Coaching Opportunity
Date Range
Transaction ID Type Channel GEHA Score UMR Response UMR Comments Coaching Error Category Response Date Actions

062f0c65
ATA
 Chat
85
Agrees

Agreed — advocate should not have sent claim for reprocessing. Will coach.
Yes
Job Knowledge
 03/12/2026

1eaa662d
ATA
 Chat
78
Disagrees

UMR disagrees — advocate correctly identified the claim in question based on the DOS provided by the member.

No
Job Knowledge
 03/12/2026

c9182af3
Random
 Call
94
Agrees

Acknowledged. Minor documentation gap noted.
Yes
Documentation
 03/10/2026

d3e71bc4
Random
 Email
88
Agrees

Will address template usage with advocate.
Yes
Communication Skills
 03/10/2026

f82a91d5
ATA
 Call
92
Agrees

Agree with adjusted score. Advocate needs refresher on hold procedures.
Yes
Policy & Procedures
 03/09/2026