URAC Health Network v. 6.0 -- N-CR 1 and N-CR 5: Facilities Credentialing

The Network standards V.6.0 has a new interpretation for the initial and recredentialing of facilities.  The change affects the eight mandatory elements, N-CR 1(b)(i), (ii), (iii), (iv) (scope of the credentialing program) and N-CR 5(b), (d), (j), and (k) (initial and recredentialing application). The requirements include the review and collection of at least the following criteria:

• State licensure information
• Medicare Medicaid certification status (via OIG), accreditation status may also be collected
• A signed and dated initial and recredentialing application with attestation

The last requirement can also be achieved by the network’s online verification and print out.

This new requirement is causing many of our clients to scramble to collect applications and requested criteria in time for the URAC onsite visit.  It is more time consuming than expected.  We suggest that the credentialing department conduct a gap analysis of its facility credentialing files to determine what the files need and to send out applications for initial (if never credentialed) and recredentialing (every 3 years). The scope of “facilities” as defined by URAC includes:

• Acute in-patient facilities such as hospitals)
• Skilled nursing facilities
• Home health agencies
• Free standing surgical centers

However, URAC will hold you to the scope described in your policy or credentialing plan.

If this seems like a big task for your organization, remember that URAC generally has been receptive to action plans for a new implementation.  Your action plans should include the date the operation change was defined, the action to complete, and the dates for the actions.  For example, an action plan might state that during a review of URAC standards on September 1, 2010, the credentialing department discovered that a new process was required for facility credentialing.  Applications and cover letters were sent out to # of facilities on September 8, 2010 to request a signed application and criteria defined in the cover letter (attach example of application and letter).  It is our intent to process 50% of all facilities by December 1, 2010 and the remaining 50% by March 1, 2011.  Hopefully these dates occur before your URAC onsite audit to ensure that you achieve full compliance with the eight mandatory elements affected by the change in N-CR 1 and N-CR 5.