Documentation

So, you've finally hit "submit" on your URAC AccreditNet application. 

In the following 3 minute video, I explain why you shouldn't be worried that URAC wants more information from you, even after you've spent months assembling the perfect URAC application.

The newer modules (like PBM and DTM) have a new citation system that I've written about elsewhere.  The new system is in many ways an improvement, but has one problem I've identified so far: when you click "Remove Evidence" to delete a document, it may not delete it completely.

In the following 2-minute video, I talk about this issue, which I consider a glitch, and how to work around it when you want to remove a document.

This standard provides:

The organization has a clearly defined organizational structure outlining direct and indirect oversight responsibility throughout the organization.

It is rather easy to demonstrate your compliance with Core 1 – submit organization charts.  However, you’ll save yourself some trouble if you are mindful about how complete your organization charts.  We recommend that the chart(s) you submit include:
•    All the relevant supervisory relationships among managers
•    The medical director
•    All the relevant committees

Are your policies and procedures describing your non-certification appeals process available upon request to any patient, provider, or facility rendering service?

If you answer "yes" to this question, you're only partly on your way to meeting the requirements of URAC Health Utilization Management standard 30. One more question to go:

Does your P&P say that it's available to any consumer, provider, or facility?

If you say "no" to this question, it's time to revise your policy.

HUM 30 provides, in relevant part, that:

The organization maintains a formal process to consider appeals of non-certifications that includes:

* * *
(b) Written policies and procedures that:

* * *
(iii) Are available, upon request, to any patient, provider, or facility rendering service. (Primary)

Remember, in the world of URAC (or any other accreditation program), if it isn't documented, it isn't happening. So, it is not merely enough that you P&P is available, but it must say that it's available. And, you must submit this documentation with your application in order to avoid getting a comment from your reviewer asking for more documentation.

One more thing: This is a primary element of a mandatory standard, so failure to provide this documentation could cost you the full accreditation you're hoping to earn.