The Basics

This standard requires that your organization's interventions are consistent with and supported by current evidence-based medical practice.  In addition, the interventions must be approved by either the senior clinician, a clinical advisor, or designated clinical oversight committee.  In addition, the standard suggests that your organization be prepared to provide to either a requesting purchaser or a requesting consumer a list of the evidence on which the interventions are based and the level of such evidence.

Management Tips

Your organization's DTM program description or similar policies and procedures should describe the process by which you establish evidentiary support for your interventions.  That process must include some sort of clinical evaluation, although you have the option as to whether to take it to your senior clinician, a designated clinical advisor, or your clinical committee.  Whichever approach you take, however, remember to make sure that the implementation of the process is documented clearly.

URAC Accreditation Tips

The requirement that your interventions be evidence-based (or at least based on best practices in the absence of evidence) is mandatory, as is element requiring clinical oversight of that evidence.  The remaining portions of the standard are "leading indicators", and therefore are optional.

The DTM program description or comparable policies and procedures will be all that you need for the desktop review.

The on-site reviewer will examine the documentary evidence of the clinical examination of the evidence.  That may take the form of committee minutes or other documentation.  In addition, the reviewer is likely to discuss this process with clinical staff members.