The Basics

This standard contemplates that not all of your existing contracts with participating providers contain all of the requirements of the previous several standards.  Rather than forcing your organization to go back and amend all of the extant, noncompliant participating provider agreements, URAC allows you to "fix" to these agreements by using your provider manual or other similar document that describes the relationship between your organization and the providers in your network.  So long as your provider manual contains all of the required provisions of the previous several standards, or, in the alternative, you provide instructions to your providers on how to obtain the documents that incorporated these required elements into your relationship with disputing providers, you need not go back and amend old, noncompliant agreements.  However, note that, on an ongoing basis, your new contracts do need to comply with the previous several standards.

Management Tips

The simplest way to take advantage of this standard is to make sure that your provider manual contains all of the requirements included in the previous several standards.

URAC Accreditation Tips

The standard carries any weight of 4, and its elements are primary.

See N-NM 7 for a description of the desktop and on-site review requirements.