URAC WCUM

The v. 4.1 "upgrade" for WC UM 33 is billed as a "clarification of intent", which sounds minor. However, for some applicants, the "clarification" could be a bigger deal than might be suggested.

The standard's purpose is to establish a time frame for notification of the patient and provider in the event of expedited appeals. The previous version (v. 4.0) read:

Expedited appeals are completed with verbal notification of determination within 72 hours of the request followed by a written confirmation of the notification within 3 calendar days. (Primary)

What is unclear about this is to whom each of these two notifications, verbal within 72 hours and written within 3 days, must go. Version 4.1 clears that up:

Expedited appeals are completed with verbal notification of determination to the requesting party within 72 hours of the request followed by a written confirmation of the notification within 3 calendar days to the patient and attending physician or other ordering provider or facility rendering service. (Primary)

So, the 72-hour verbal notice need go only to the requesting party, whether it be the provider or the patient. Only the written notification needs to go to both the consumer and the provider. This surely will be a relief to those URAC applicants that were playing it safe and giving verbal notice to everybody in the first 72 hours.

Playing it safe with a standard like this is not a bad strategy: you don't mess around with mandatory standards.