The Basics

The standard adds details to the more general Core standards regarding marketing your organization's services.  It requires that your organization implement protections to ensure that marketing and sales activities do not misrepresent:

• benefit plans;
• network provider availability and accessibility;
• information about what is covered by your plan, including exclusions and limitations;
• any administrative requirements the consumer needs to know; and
• and medical management (utilization management, case management, disease management) requirements.

Make sure you are familiar with your organization's policies and procedures on this topic.  It will not be enough to know the requirement generally, but rather how your organization implements it.

Management Tips

The organization's policies must apply not only to written materials in both print and on the organization's website, but also to information conveyed to consumers by agents, brokers, and consultants.  The interdepartmental mechanism required of printed and website materials by the corresponding Core standard should be detailed enough to address the more specific requirements of this standard.  In addition, be sure your policies and procedures overtly address how to train agents, brokers, and consultants so that they convey accurate information about your organization to consumers.

URAC Accreditation Tips

Three of the elements of the standard are mandatory; the other two are weighted 4.

For the desktop review, submit:

• applicable policies and procedures;
• training manuals agendas and attendance records for employees, brokers, agents, and consultants;
• 2-3 samples of marketing brochures, along with documentation that they have been approved by the interdepartmental process;
• a screenshot of consumer materials on your realization website.

The on-site review will include a more complete examination of your marketing materials, as well as an interview of both customer service employees and marketing management and staff members.