This CMS standard provides:

The MAO must have written policies and procedures for selection and evaluation of providers and follow a documented process for facilities regarding initial credentialing and recredentialing.

The URAC standard that implements this standard is URAC MAP-NM 3:

The Basics

This standard requires that your organization credential and re-credential facilities in your network by, at least, determining that each facility is licensed to operate in the state and in compliance with all other applicable regulations, and that it is either accredited or meets your organization's standards.

No doubt you will find your organization's policies and procedures complying with the standard in your credentialing plan or similar document.

Management Tips

There is nothing particularly special imposed by this standard above and beyond what URAC already requires you to do with facilities, with the exception of an overt demonstration that your facilities are either accredited or meet your standards.  That being said, it still makes sense to very clearly articulate, perhaps even in the language of this standard, these requirements for your facilities.  In addition, as always, make sure your credentialing staff is well trained in the requirements for facilities imposed on Medicare Advantage plans.

URAC Accreditation Tips

As is the case with most credentialing requirements, submission of your policies and procedures and/or your credentialing plan is an essential start to the documentation submission process.  In addition, for the desktop review, it makes sense to submit information about accreditations that you require of your facilities, as well as sample committee minutes demonstrating the application of your facilities credentialing requirements.

During the on-site review,the reviewer will interview the credentialing and provider contracting staff, as well as the medical director.  Issues covered will be credentialing criteria for both practitioners and facilities, including requirements for licensing, accreditation, Medicare certification, and anything else that applies.  The reviewer is likely to ask under what circumstances you would not recredential a facility.  The reviewer also will incorporate the requirements of the standard into his/her review of 30 provider credentialing files.  In addition, he/she will examine credentialing committee minutes for evidence of compliance with the standard.