URAC

Question 1

According to URAC practitioners must be notified of credentialing decision within how many days?

Answer 1

10 Days

Question 2

According to URAC, within how many days must the practitioner be notified of credentialing decisions?

Answer 2

10 days

Question 3

Attestation must state that the information submitted is complete and accurate?

Answer 3

URAC

Question 4

According to URAC - within how many days must the practitioner be notified of credentialing decisions?

Answer 4

10 Days

Question 5

According to URAC, within how many days must the practitioner be notified of credentialing decisions?

Answer 5

10 days

Question 6

According to URAC, the credentialing application must include what?

Answer 6

Release of information

Question 7

What is the URAC appointment timeframe?

Answer 7

every 3 years to the month & day

Question 8

As defined by state law who had the appointment timeframe not to exceed 3 years?

Answer 8

URAC

Question 9

Who allows state licensing board to verify education if the state board verifies the credentials?

Answer 9

URAC

Question 10

What is the accepted time limit of malpractice history for URAC?

Answer 10

6 months

Question 11

URAC standards require PSV of what two elements when initially credentialing a provider.

Answer 11

State license, highest level of education

Question 12

URAC standards require the organization to provide written notification to providers within how many calendar days of the credentialing determination?

Answer 12

10 days

Question 13

According to URAC what must be verified using primary source?

Answer 13

State licensure, highest level of education

Question 14

According to URAC who should oversee the clincial aspects of the credentialing program within the organization?

Answer 14

the senior clinical staff person

Question 15

Who/what is the highest level of authority for URAC?

Answer 15

the credentials committee may delegate “clean” applications to senior clinical staff person

Question 16

Per URAC standards, who has final authority to approve/disapprove applications?

Answer 16

credentials committee

Question 17

According to URAC how is the re-credentialing cycle calculated

Answer 17

mm/yy to mm/yy

Question 18

According to URAC, who should oversee the clinical aspects of the credentialing program within the organization?

Answer 18

Senior clinical staff person

Question 19

According to URAC, PSV or secondary PSV may not be collected

Answer 19

more than 6 months prior to credentialing committee

Question 20

According to URAC, no credentialing application may be accepted if it is signed and dated more than:

Answer 20

180 days prior to credentialing committee review

Question 21

Who gets credentialed @ URAC?

Answer 21

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.

Question 22

URAC applications includes:

Answer 22

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.

Question 23

URAC education verification time limit

Answer 23

6 months

Question 24

URAC verification of training time limit

Answer 24

6 months

Question 25

Does URAC require verification of board certification?

Answer 25

verify board certification if this is the highest level of education

Question 26

What is the time limit for verification of Board Certification for URAC?

Answer 26

6 months

Question 27

Verification time limit of DEA according to URAC

Answer 27

6 months

Question 28

Non discrimination according to URAC

Answer 28

credentialing program includes a statement that the organization will not discriminate against providers

Question 29

Medicare/Medicaid Sanctions Exclusions requirement by URAC

Answer 29

required to be reported on application

Question 30

current competence is determined by URAC how?

Answer 30

not addressed

Question 31

Board Certification: URAC Health Plan Accreditation Guide, Version 7.2, 4/2014

Answer 31

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.

Question 32

Complaints - URAC Health Plan Accreditation Guide - Version 07.2 04/2014

Answer 32

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.

Question 33

Compliance with Law - URAC Health Plan Accreditation Guide: Version 7.2, 4/2014

Answer 33

Standards require compliance with all applicable federal, state, and local laws.

Question 34

Continuing Medical Education - URAC Health Plan Accreditation Guide, Version 7.2, 4/2014

Answer 34

Not specifically addressed.

Question 35

CVO's/Delegation: URAC Helath Plan Accreditation Guide: Version 7.2 4/2014

Answer 35

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:

Question 36

Criminal Background Checks: URAC Health Plan Accreditation Guide, Version 7.2 04/2014

Answer 36

Not specifically addressed.

Question 37

Current Competence: URAC Health Plan Accreditation Guide, Version 7.2 4/2014

Answer 37

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.

Question 38

Designated Equivalent Sources: URAC Health Plan: Accreditation Guide: Version 7.2 4/2014

Answer 38

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.

Question 39

Disaster or Emergency Management Plan Privileges URAC Health Plan Accreditation Guide Version 7.2 4/2014

Answer 39

Not specifically addressed.

Question 40

Drug Enforcement Agency Certificate (DEA) or State Controlled Dangerous Substances Certificate; URAC Health Plan Accreditation Guide, Version 7.2 04/2014

Answer 40

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.

Question 41

Education: URAC Health Plan Accreditation Guide, Version 7.2 4/2014

Answer 41

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.

Question 42

Felony Convictions: URAC Health Plan Accreditation Guide, Version 7.2, 4/2014

Answer 42

Not specifically addressed

Question 43

URAC

Answer 43

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