URAC P-NM 15 and N-NM 15 -- v. 5.1 revision

In what some will call a Band-Aid for a serious wound, URAC merely renamed the standard which, in both the Health Plan and Health Network accreditation standards describes the requirements for participating provider dispute resolution where the dispute is merely administrative (and neither clinical nor quality-related). The old title for the standard is “Participating Provider Dispute Resolution Process: Type A”, while the new one adds “ – Administrative” at the tail end of the title.

For the sake of context, this is the standard that was added in v. 5.0 to bring some order to the mess created by the drafting of the comparable standard in v. 4.0. As I outlined long ago in a blog to describe the long and unhappy history of these standards, the v. 5.0 standards only compounded the problem, and renaming this one seems like less than a half-measure.

The best way to understand this whole series of standards dealing with participating provider dispute resolution is still to read an explanatory note that was posted on the URAC website a few months after I posted my initial blog on the issue. You can read that note in my blog.

One can only hope that the clarity expressed in that Web site note will be replicated in v. 6.0, whenever URAC issues that version.