URAC Evidence: Policies and Procedures

Over the years, many applicants have taken the sound approach of borrowing language directly from URAC to use in their policies and procedures (P&Ps). Tracking URAC's language closely often can help you avoid quibbling with reviewers.

However, cribbing URAC language may not be sufficient. More often than not, URAC language is written at the "policy" level, with not much procedure attached. URAC reviewers have been known to reject such high-level statements of policy, under the theory that a proper P&P should guide your staff on how to implement that policy.

So, then, what should go in the P&P? Well, it varies from one standard to the next, but the best rule of thumb is, in my opinion, to reference the program guide as much as possible, particularly the sections under the standard called "Evidence for Meeting the Standard", "Interpretive Information/Commentary", and "Points to Remember". If you can weave some of the comments from those sections into an explanation of how you implement your policy, and do so in such a way that a new employee would have a pretty good idea as to what he or she needs to do in order to implement that policy, then you've probably hit a URAC home run. If not, you may get the P&P returned to you in the Desktop Review Summary with a comment indicating that the P&P is not sufficiently detailed to demonstrate compliance with the intent of the standard.