URAC Flashcards
According to URAC practitioners must be notified of credentialing decision within how many days?
10 Days
According to URAC, within how many days must the practitioner be notified of credentialing decisions?
10 days
Attestation must state that the information submitted is complete and accurate?
URAC
According to URAC - within how many days must the practitioner be notified of credentialing decisions?
10 Days
According to URAC, within how many days must the practitioner be notified of credentialing decisions?
10 days
According to URAC, the credentialing application must include what?
Release of information
What is the URAC appointment timeframe?
every 3 years to the month & day
As defined by state law who had the appointment timeframe not to exceed 3 years?
URAC
Who allows state licensing board to verify education if the state board verifies the credentials?
URAC
What is the accepted time limit of malpractice history for URAC?
6 months
URAC standards require PSV of what two elements when initially credentialing a provider.
State license, highest level of education
URAC standards require the organization to provide written notification to providers within how many calendar days of the credentialing determination?
10 days
According to URAC what must be verified using primary source?
State licensure, highest level of education
According to URAC who should oversee the clincial aspects of the credentialing program within the organization?
the senior clinical staff person
Who/what is the highest level of authority for URAC?
the credentials committee may delegate “clean” applications to senior clinical staff person
Per URAC standards, who has final authority to approve/disapprove applications?
credentials committee
According to URAC how is the re-credentialing cycle calculated
mm/yy to mm/yy
According to URAC, who should oversee the clinical aspects of the credentialing program within the organization?
Senior clinical staff person
According to URAC, PSV or secondary PSV may not be collected
more than 6 months prior to credentialing committee
According to URAC, no credentialing application may be accepted if it is signed and dated more than:
180 days prior to credentialing committee review
Who gets credentialed @ URAC?
The organization verify the professional qualifications of all participating providers as well as facilities that provide covered health care services to consumers. All practitioners listed in the directory must be credentialed.
URAC applications includes:
History of sanctions, loss or limitation of privileges or disciplinary activity; disclosure of any physical, mental or substance abuse problems which without reasonable accommodation impede the practitioners ability to provide are according to accepted standards.
URAC education verification time limit
6 months
URAC verification of training time limit
6 months
Does URAC require verification of board certification?
verify board certification if this is the highest level of education
What is the time limit for verification of Board Certification for URAC?
6 months
Verification time limit of DEA according to URAC
6 months
Non discrimination according to URAC
credentialing program includes a statement that the organization will not discriminate against providers
Medicare/Medicaid Sanctions Exclusions requirement by URAC
required to be reported on application
current competence is determined by URAC how?
not addressed
Board Certification: URAC Health Plan Accreditation Guide, Version 7.2, 4/2014
verify board certification, if applicable, or the highest level of education. This is required for initial credentialing only, unless the board certification expires, or if there is no record of the verification in the practitioner’s record. If a physician has multiple board certifications, then at a minimum, verify for the specialty under which the practitioner will be listed in the directory. PSV can include the AMA master file, AOA master file, or special board of registry. URAC recognizes those sources that the ABMS has designated as primary equivalents as ones that are primary as well. An organization can rely on the verification activities of state licensing boards. If this is done, it should be noted in the credentials file. Confirm that the state board does verify a credential before relying on the board. Time limit six months.
Complaints - URAC Health Plan Accreditation Guide - Version 07.2 04/2014
There must be a mechanism for conducting additional review and investigation of credentialing applications in cases where the credentialing process reveals factors that may affect the quality of care or services delivered to consumers. Parameters or triggers of potential quality of care issues that require further investigation must be included in a policy.
Compliance with Law - URAC Health Plan Accreditation Guide: Version 7.2, 4/2014
Standards require compliance with all applicable federal, state, and local laws.
Continuing Medical Education - URAC Health Plan Accreditation Guide, Version 7.2, 4/2014
Not specifically addressed.
CVO’s/Delegation: URAC Helath Plan Accreditation Guide: Version 7.2 4/2014
The organization can delegate credentialing if it does, it must establish and implement criteria and assessment processes prior to the delegation of functions, including a process to conduct a review of the potential contractor’s written policies and documented procedures and capacity to perform delegated functions. There must be a written contract:
Criminal Background Checks: URAC Health Plan Accreditation Guide, Version 7.2 04/2014
Not specifically addressed.
Current Competence: URAC Health Plan Accreditation Guide, Version 7.2 4/2014
Not specifically addressed. The credentialing program defines the organization’s criteria for qualification as a participating provider. The credentialing program includes a statement that credentialing decisions will be based on multiple criteria related to professional competency, quality of care and the appropriateness by which health services are provided.
Designated Equivalent Sources: URAC Health Plan: Accreditation Guide: Version 7.2 4/2014
URAC does not use the language “designated equivalent sources”. Primary source verification may include state licensing board, school/residency training program, board certification via the AMA master file, AOA master file, ECFMG or special board of registry. NPDB for sanctions from state licensing boards and Medicare/Medicaid. An organization can rely on the verification activities of state licensing boards. If this is done, it should be noted in the credentials file. Confirm that the state board does verify a credential before relying on the board. Time limit six months.
Disaster or Emergency Management Plan Privileges URAC Health Plan Accreditation Guide Version 7.2 4/2014
Not specifically addressed.
Drug Enforcement Agency Certificate (DEA) or State Controlled Dangerous Substances Certificate; URAC Health Plan Accreditation Guide, Version 7.2 04/2014
evidence of current DEA certificate or state controlled dangerous substance certificate is submitted with application; if applicable. The organization may either collect a copy of the certificate or the certificate member. Verification time limit is six months.
Education: URAC Health Plan Accreditation Guide, Version 7.2 4/2014
History of education and professional training included on application. PSV can include state licensing board, school residency training program. An organization can rely on the verification activities of state licensing boards. If this is done it should be noted in the credentials file. Confirm that the state board does verify a credential before relying on the board. Verification not required if the practitioner is board certified. Time limit six months.
Felony Convictions: URAC Health Plan Accreditation Guide, Version 7.2, 4/2014
Not specifically addressed
URAC
Credentialing Program Plan defines participating providers and facilities who must be credentialed. At a minimum: Participating providers who are contracted to provide health care services to consumers. Facilities that provide covered health care services to consumers. Practitioners, facilities listed in directory. Stands for: Utilization Review Accreditation Commission
