The Basics

Is a standard sets forth the requirements for your organization's written description of the credentialing program, often described as the Credentialing Plan.  (Note that many organizations have no document called Credentialing Plan, but a collection of credentialing P&Ps.  From here on, when I refer to Credentialing Plan, I'll mean both -- or either.)  These requirements include:

• credentialing committee approval
• a definition of the scope and objectives of the program
• the responsibilities of the committee, the senior clinician, and staff members
• selection criteria for anticipating providers, including documents to be collected in order to demonstrate compliance with those requirements
• procedures for verifying information collected in the credentialing process
• the organization's rules about maintenance of credentialing files
• an antidiscrimination statement
• a requirement that the credentialing committee review and update the written description annually

Management Tips

Noted that this document is a good document in which your organization can describe how it intends to meet the access and availability standards required by both Core and Network Management standards on access and availability.

URAC Accreditation Tips

This standard has three mandatory elements; the rest are weighted between 2 and 4.

For the desktop review phase, submit the credentialing plan, the medical director's job description, and credentialing committee minutes showing that committee's most recent annual approval of the credentialing program plan.

During the on-site review, the reviewer will choose roughly 3 dozen initial and re-credentialing files in order to verify implementation of the credentialing program description.  You can expect about half of the files to be initial credentialing files, and half to be recredentialing files.