The Basics

Some organizations delegate credentialing to other organizations, like facilities, provider groups, or credentials verification organizations (the "CVOs").  URAC has four standards in the Core module that address delegation generally (Core 15-18).  

This standard establishes two requirements in addition to the requirements contained in those four standards.  

• If your organization delegates credentialing to another organization, it must retain authority to make the final credentialing determination.  Part of this process is likely to involve your organization comparing a list of approved providers forwarded from the delegate to add to your network against a historical list of providers previously terminated or denied in order to determine whether the providers are to added to your network.
• In addition, the organization must conduct surveys of its credentialing contractors no less frequently than every three years.  These surveys must be on site visits, and should be conducted according to your credentialing plan or a policy and procedure that directly addresses the performance of on-site surveys of delegated entities that conduct credentialing for your organization.  Typically, a standardized audit form is used for such on-site audits.  The on-site audit should involve a random sample of complete credentialing files that the contractor has administered on your organization' behalf.  The sample size should be at least 10% of those files, but in no case fewer than 10 files nor more than 30 files.

Management Tips

If this is your organization's first time through the process of accreditation, you are allowed a three-year phase-in of your site visits for delegated entities.  You must complete 15% of your surveys by the end of the first year, 50% by the end of the second year, and the remaining reviews conducted by the end of the third year.

Naturally, if your organization does not delegates credentialing, this standard is not applicable.

URAC Accreditation Tips

This standard carries a weight of 4.  The element that requires that your organization retained final authority over credentialing determinations is primary, while the element requiring on-site surveys every three years is secondary.

At the desktop review stage, you should submit your credentialing plan, a template delegation agreement, your on-site audit tool, sample credentialing committee meeting minutes in which the committee demonstrates that it retains final authority for credentialing decisions, and/or sample committee meeting minutes that document a decision to delegate or not to delegate credentialing to another entity.

The on-site reviewer will examine credentialing committee meeting minutes from the last four years. In addition, the reviewer will look at "delegation binders" for each of several of your contractors.  Each delegation binders should contain the delegation agreement, reports submitted by the contractor, completed audit sheets from your on-site surveys, and documentation of other required oversight activity.