The Basics

These standards require that your organization, as a part of the initial credentialing process for PCPs and high-volume specialists, conduct an onsite review of the providers' offices or facilities.

The reviewer conducting the review must:

• carry a photo ID with his/her full name;
• carry identification that includes your organization's name, and
• schedule the review at least 5 business days in advance unless the provider agrees to a shorter notice.

The reviewer must use a review tool that addresses:

• patient access (including both access for the disabled and ability to get appointments in a timely manner); and
• the provider's P&Ps about infection control, hazardous materials, medication; fire safety, emergencies, laboraty, and maintenance of medical equipment.

The reviewer must give to the provider the review standards and/or the review process upon request.  

At a minimum, the onsite review should include a random sample of one consumer medical record to insure that the record is well-organized, complete, and in a consistent format.  In addition, there must be proper documentation and relevant information as described in the previous standard.

Management Tips

Be sure all the required components of these standards are included in your P&P on intial credentialing onsite reviews.  In addition, it will be incumbent on you to make sure your staff is well-trained on those policies and on the URAC standard giving rise to those policies.

URAC Accreditation Tips

For the desktop review, provide the P&P as well as the onsite credentialing audit tool.

The onsite review will involve an examination of files demonstrating compliance with the standard as well as an interview of both credentialing managers and staff members who conduct onsite credentialing reviews.