URAC Health Plan -- Mandatory Standards

So what are the mandatory standards?

URAC has always had mandatory standards. However, only with version 1.0 of the Core standards developed in the early part of this decade did the current notion of “mandatory standard” emerge. Mandatory standards typically, but do not always, have to do with consumer protection. A mandatory standard is any standard that has a weight of “5”.

In order to be fully accredited, an applicant must score at least 2 out of a possible 4 points on every mandatory standard. You can only get a score of two if you pass all of the “primary” elements of a standard. Therefore, what really is mandatory is that an applicant pass all of the primary elements of all of the mandatory standards.

The mandatory standards for the Health Plan (v. 5.1) module are:

Network Management
P-NM 3-Provider Selection Criteria
P-NM 4-Out of Network and Emergency Services
P-NM 6-Provider Relations Program
P-NM 7-Participating Provider Written Agreements
P-NM 8-Participating Provider Written Agreement Exclusions
P-NM 18 – Participating Provider Suspension Mechanism for Consumer Safety
Credentialing
P-CR 1 – Practitioner and Facility Credentialing
P-CR 10 – Consumer Safety Credentialing Investigation
P-CR 14 –Participating Providers Credentials Monitoring

Naturally, an applicant for Health Plan accreditation also will have to meet the mandatory standards for both the Core module, found here, and the Health Utilization Module, found here.