The Basics

As a health plan, your organization communicates with the providers in its network.  This standard sets forth the minimum requirements of your program of participating provider communications:

• a provider communications plan that includes:
  • new provider orientation;
  • network activity updates;
  • information about changes in fees or other contract issues;
  • guidance on getting information about such things as benefits, eligibility of members, formularies, and appeals;
  • guidance on how to obtain provider manuals and similar documents.
• mechanisms to help participating providers navigate your provider network; and
• one more means of receiving suggestions from providers about how you can provide better service.

Most organizations address the standard by developing a comprehensive provider communications plan that not only lists all these requirements, but describes in some detail how your organization meets those requirements.  Check to see if your organization has such a plan.

Management Tips

Our recommendation is that you handle the requirements of this standard by developing a comprehensive provider communications plan that includes all of the above-described elements.  Such a plan should be detailed enough so that a newcomer to your organization, asked to take up responsibility for the execution of some component of this plan, would know, in a general sense, how to do his or her job.

Standardization of your approach to communicating with participating providers could also come in the form of a standard orientation packet that your organization provides to each participating provider.  In addition, provider newsletters are useful means of meeting the requirements of the standard, particularly when developed in the context of a comprehensive provider communications plan.

URAC Accreditation Tips

All of the elements, except for the one requirement a feedback mechanism for providers, are weighted 4.  That element is weighted 3..

You will have a lot of flexibility around the documents you submit in the desktop phase.  Obviously, we recommend that you start with the communications plan described above, and then submit examples of the implementation of the plan, such as provider newsletters, orientation checklists, "blast fax" communications to members of your network, etc.

The on-site reviewer will get most of his or her information about the standard from an interview of provider relations management personnel.  We recommend that, in the course of that interview, provider relations managers be prepared to show the reviewer documentary evidence of the implementation of the communications plan (provider newsletters, orientation package, etc.).