The Basics

This standard applies only to health networks (not health plans) on their first or second time through the accreditation process.  

• For first-time applicants, your organization must have credentialed at least 100 practitioners by the time of the on-site review.  
• After that, your organization must credential at least 50% of participating providers within two years of the date of initial accreditation.  
• Finally, 100% of participating providers must be credentialed within three years of initial accreditation.  
• After that point, your organization must re-credential all providers no less frequently than every three years.

URAC Accreditation Tips

This standard carries the weight of 4, and all of its elements are primary except for the element requiring credentialing of all participating providers within three years of initial accreditation.

Documentation for the desktop review stage is a combination of the credentialing plan and an attestation signed by leadership within the credentialing program indicating the percentage of providers that are credentialed under URAC standards at the time of submission of that documentation.  In addition, that plan should set targets for implementation over the following three years.  Make sure to provide the total credentialed practitioners (numerator) and the overall total number of practitioners in your network(denominator).  Be prepared to present the percentage or number of providers delegated in the network as well.  It often helps the reviewer get a sense for how great of a credentialing task you may or may not have to get your network providers credentialed.

The on-site reviewer will examine credentialing committee minutes over the last four years.  In addition, he/she will interview credentialing leadership about the implementation of the credentialing plan.