The Basics

CM 3 requires that the CM programs P&Ps assure that staff members have access to appropriately licensed and trained physicians in case they need advice or counsel.   This is important to note -- the physician can be an employee or a consultant advisor.  

Management Tips

Your P&Ps should specifically address how and when management staff is expected to consult a physician.  In addition, staffing needs to be adequate so that the need to consult a physician is not delayed.  The P&Ps also should address the qualifications of the physician(s) to whom case management staff has access.

URAC Accreditation Tips

This is a mandatory standard. 

The documentation for desktop review is straightforward -- a policy and procedure providing for ready access for case managers to appropriate phsycian expertise, job descriptions of the case managers and physician that describe this relationship, and a list of the physician advisors.  

The onsite review will confirm these relationships through a combination of document review and an interview with one or more of the physician advisors.