URAC P-MR 4

This simple standard requires that your communications plan assures that you notify consumers of benefit changes before they happen.  Most applicants appropriately submit a P&P to this effect and an example (newsletter or other member correspondence) of such prior notice.

While this is appropriate documentation, it overlooks that URAC also requests that applicants submit “Summary listing of all changes in covered benefits in the last two years, including the date of such changes.”

URAC’s reviewers want this information so that, during the onsite review, they can pick one or more such benefit changes and ask to see evidence that the announcement about the benefit change went to consumers before the effective date of the change. This suggests a practice note – since you know before the onsite review what this list looks like, go back and see if, in fact, your organization sent the notice timely. If not, diagnose why, and fix the systemic problem that led to that error before the onsite review. That way, while you cannot change history, you’ll at least be prepared to say “yes, we’re aware of our non-compliance with this standard on such-and-such a date, we diagnosed the problem, fixed the source of the problem, and feel confident that this won’t happen again.”

While this does not guarantee that you won’t get “dinged” for your error, it may be that the penalty will be reduced, given your documented, good-faith effort to fix the problem.