The Basics

This standard requires that, in addition to the QIP described in the previous two standards, you also have preventive care programs that include both preventive health guidelines that are age-specific for your organization's entire consumer base, and the dissemination of those guidelines to participating providers.  These guidelines can be either developed externally and adopted by your senior clinicians or developed and approved internally by qualified clinicians.

Management Tips

Your P&Ps on this topic should clearly spell out the development, review, and approval processes for preventive guidelines.  In addition, it will be important that they clearly mandate dissemination of those guidelines to participating providers and describe the mechanism for such dissemination.

URAC Accreditation Tips

For the desktop review, submit your P&P as well as a sample of both the preventive guidelines and evidence of how you provided those guidelines to members of your provider network.

During the onsite review, the reviewer will examine your documentation of review and approval of your guidelines, and will interview senior clinical leadership about that process.