The Basics

This simple, straightforward standard prohibits your organization from reversing the decision to certify unless you receive information that:

• is new
• is relevant
• was not available at the time of the certification decision.

Management Tips

If you intend to have the power to reverse your own certification decisions, make sure you describe the circumstances under which you will do that in a P&P.  Your P&P also should describe the specific process by which your staff will document that process.  It will be important to affirmatively demonstrate that your new information was not available when you first approved the request for certification.  The burden is on your organization to demonstrate this, so be sure the documentation is clear.

URAC Accreditation Tips

The standard has a weight of 4.

For the desktop review stage, submit the P&P that describes your process. 

It would not be uncommon for the URAC reviewer, during the onsite review, to fail to pull a reversal of a certification decision in her random file pull.  To make sure you're doing this right, do your own audit of such reversals before the URAC review.