URAC P-CR 13& N-CR 13 -- v. 5.1 Proposed Revision -- Credentialing Determination Notification

The existing standard in both the Health Plan and Health Network standards reads:

The organization provides written notification to providers of the
determination of the providers’ credentialing application within 60
calendar days of the determination. (Secondary) [Wt = 3]

The new standard reads:

The organization provides written notification to providers of the
determination of the providers’ credentialing application within 10
business days of the determination. [4]

This revision carries two important changes. The substantive change is to reduce the notification requirement deadline from 60 calendar days to 10 business days, slicing about 6 weeks off the process. While most of our clients will meet the new timeline, some applicants will have to tighten up their processes.

The second change is an increase in the weight from 3 to 4. Because this is a single-element standard, however, we believe that it will carry less relative weight in the new system than it does now.