The Basics

So that your organization and in the auditors can see a ready reference for the reviews your organization conducts, you must maintain a log of all of your independent review case files.  That log must contain, for each case:

• the date that the referring entity made its request of your organization to conduct an independent review;
• the day your organization received the information packet;
• the date by which your organization must receive any additional information from a consumer, provider, or referring entity;
• a description of the issue in the case;
• the name of the referring entity;
• whether the case is standard or expedited;
• what your organization determines;
• the date of the determination; and
• the date of the notification of determination.

Management Tips

Again, the key to complying with the standard from the perspective of management is to make sure that your policy and procedure describing the log complies with the standard, that the log itself complies with the standard, and that the staff is trained on how to use the log. It will be important that members of your staff complete each blank in the log.

URAC Accreditation Tips

Each of the nine elements of this standard is worth two points.

For the desktop review, submit both policy and procedure and a screenshot of the case file log.

The on-site reviewer will need the log to be in the room in which you will be working from the very beginning of the review.  Right after the introductions, she will use the law to select at least 30 case files for her to review.  Make sure you can retrieve those files within not much more than an hour.  Technically, you have 75-90 minutes retrieve files, but the reviewers appreciate it if you can retrieve them in less time than that.