The Basics

This is standard requires that your communications plan provide that, upon enrollment in one of your organization's benefit plans, a consumer is provided with a means of accessing it a participating provider directory.

In addition, your communications plan must assure consumers of ongoing access to up-to-date participating provider lists.  This might take the form of a phone number to call to talk to a customer service representative, the provider directory on the website, or some similar constantly-updated provider list.

Management Tips

Make sure that your communications plan addresses all of the ways that you provide your provider lists to consumers, both upon enrollment and on an ongoing basis.  Furthermore, it will be important that your customer service representatives are up-to-speed on all the various mechanisms that you have in place to provide such information.  Make sure your training covers it.

URAC Accreditation Tips

The two elements of the standard are weighted 4.

For the desktop review, provide not only your communications plan, but also documentation of the implementation of the plan, such as correspondence with consumers about updated provider lists, a screenshot of your online provider directory, and consumer information with your organization's toll-free number that consumers can call in order to find participating providers.

The on-site review will be an interview of both managers and staff members in the customer service department.  This places a premium on training on the standard and your policies that implement it.