The Basics

Under this standard, your organization may not submit a credentialing application that:

• is signed and dated more than 180 days prior to credentialing committee review, or
• has verification information collected more than six months before review.

The purpose of this standard is to make sure that the credentialing committee or senior clinical staff member are reviewing information that is relatively recent.  To accomplish this, your organization must have policies and procedures to move credentialing applications through the credentialing process in a timely manner.

Sometimes, however, credentialing committees review a particular application more than once.  The standard applies only to the first time an application comes before a credentialing committee in that cycle.

If an application should fall through the cracks and have stale data, you need not make the provider go through the entire credentialing process again.  Rather, you may have the provider re-sign the attestation that declares that the information on the application is still valid and accurate.

Management Tips

To help your staff make sure that no stale applications are submitted to the committee or the senior clinical staff person, your checklist or audit sheet for each credentialing file should have an element that allows the staff person checking the application to see whether this application complies with the timeframe requirements of this standard.

URAC Accreditation Tips

The two elements of this standard each carries a weight of 4.

Documents to be submitted in connection with the desktop review should include a credentialing plan that clearly describes the applicable time frames and a checklist or audit form that allows the staff member to confirm compliance with these time frames.

The on-site reviewer will both interview credentialing staff regarding these time frames and examine three dozen or so credentialing files to assure that no stale applications have been submitted to the committee or the senior clinical staff person.