The Basics

Not unlike URAC's requirements in the UM standards for concurrent review nurses, this standard requires that case managers working in the field:

• Carry clear identification (usually a name tag with a photo and the name of the organization); and
• Cooperate with the facility's procedures for visiting.

Management Tips

The intent of this standard, of course, is to make sure relationships between the CM program and the visited facilities are smooth and clear.  Agreements trump assumptions (and even this standard), so if you have a working relationship with a particular facility that is clear and, preferably, documented, that will govern case manager behavior.

URAC Accreditation Tips

The elements of this standard weighted 2 and 4.

Again, the key is documentation.  Have a solid P&P for onsite visits, and make sure you comply with that P&P.  If your visits are governed by agreements with facilities or facility P&Ps, make sure you have a record of those agreements and/or P&Ps.  

The program guide suggests that the reviewer may accompany a case manager on such a visit.  I'd be pretty surprised if that happened in the time-crunch world of a CM review, but it's a good idea to be prepared for that possibility.  More likely is the telephonic interview, in which the URAC reviewer will randomly select a field case manager to talk to about how she arranges her visits.