The Basics

This standard requires that your organization recredential every participating provider no less frequently than every three years.

The reason for the existence of this standard is that some credentials expire.  For those that do, the organization must check to see that they are still valid.  Therefore, this recredentialing process is not quite as complete as initial credentialing.

For years, the "clock" for the three years required by the standard started on the date of the approval of the credentialing application.  However, in July 2010, this changed.  According to URAC, "per decision from Health Standards Committee 7/21/10, the 3-year credentialing cycle is to the month of the initial credentialing decision, not the specific day as indicated by previous guide language.  Rationale includes that ongoing quality monitoring checks occur (CR 16) and the 3-year cycle is not as precise as checking credentials upon expiration, so to the month is reasonable.  Per our research and Committee input, the industry’s interpretation of this cycle is to the month as well."

Management Tips

Note that the recredentialing process requires that you present the application for recredentialing to the credentialing committee whether or not there are issues to discuss.  However, you need not reverify those credentials that do not expire or change over time.  An example of such credentials is education.

Note that several organizations opt to follow standard CR 3 d(ii) that allows a credentialing committee to delegate a senior clinical person in the organization such as the Medical Director, to approve files considered “clean” and therefore does not require peer review input to make a decision in between credentialing committee meetings.   These “clean” files are later forwarded to the next possible credentialing committee meeting for a formal approval.  This formal approval is the date by which the provider must be credentialed three years later.

URAC Accreditation Tips

This standard is mandatory.

Documentation at the desktop review phase should include both the credentialing plan, outlining the recredentialing process, and a sample of your credentialing committee minutes that includes approval of the recredentialing applications.

The on-site review, in addition to the review of credentialing files, will include an examination of credentialing committee minutes and an interview with credentialing department management and staff members.