URAC P-NM 17 and N-NM 17 -- v. 5.1 revision

In amending this standard, which describes an aspect of the provider dispute resolution process for clinical and quality disputes, URAC simply clarifies that its use is limited to participating providers. It does so by amending subsection (b) to read, “Includes the right to consideration by a second-level panel and the methods to request such consideration, and a mechanism for participating providers to present relevant information.” The new language is simply the word “participating”.

The standard now reads:

The dispute resolution mechanism required under Standard NM 16: (Primary)
(a) Specifies that all disputes are referred to first-level panels consisting of at least three qualified individuals, of which at least one must be a participating provider who is not otherwise involved in network management and who is a clinical peer of the participating provider that filed the dispute; (Primary)
(b) Includes the right to consideration by a second-level panel and the methods to request such consideration, and a mechanism for participating providers to present relevant information; and (Primary)
(c) Provides for consideration to a secondlevel panel consisting of at least three individuals that comply with Standard NM 17(a) and that were not involved with the first-level panel. (Primary)

For a more complete discussion of URAC's provider dispute resolution standards, see my earlier blog.