The Basics

CR 3 sets forth detailed guidelines for the structure and responsibilities of the Credentialing Committee.  Topics covered by this standard include: 

• participating provider representation on the committee;
• the requirement that the committee assess whether candidates for credentialing or recredentialing meet reasonable standards of care and the credentialing requirements of the organization;
• making sure those standard-of-care assessments are based on appropriate input from clinical peers; and
• a host of technical requirements, including meeting minutes, oversight of credentialing staff and organizations to which the company delegates credentialing, regularly assesses the credentialing plan and P&Ps, etc.

Management Tips

In recent reviews, URAC reviewers have been known to "ding" an application that doesn't provide enough detail about the participating providers on the committee.  URAC has said that it wants, specifically, "a description of the participating provider(s) member(s) and the requirements, terms, duration, selection procedures of their committee responsibilities."

Another recently noted stumbling block has been around subsection (d)(ii).  Even where your P&Ps note that the committee has the authority to delegation the handling of "clean claims" to the medical director, if your documentation does not actually indicate that it has (or has not) so delegated, you're likely to get the following comment back from the reviewer:

"Clarify whether or not the committee delegates approval of clean applications to the senior medical director."

URAC is likely to accept a variety of types of documentation to demonstrate this, either in the form of a P&P, committee charter, or committee minutes showing the act of delegation.

URAC Accreditation Tips

Two of the elements of the standard are mandatory; the rest are weighted either 3 or 4.. 

For purposes of the application at the AccreditNet submission stage, URAC recommends a detailed organization chart of the entire credentialing program, including the committee, as well as formal credentialing plan and P&Ps.  In addition, meeting minutes from the Credentialing Committee are essential to demonstrate that the plan and P&Ps are being approved and implemented.