The Basics

This standard governs communications with providers and patients.  The organization needs to be able to receive communications from those two groups both during the business day and after hours.  In addition, you need to be able to respond to provider and patient communications within one business day.  Finally, the standard requires that your communications to providers occur during "reasonable and normal business hours" unless you have an agreement with the provider to the contrary.

Note that this standard does not apply to requests for certification.  Those time frames are covered in other standards.  This is limited to other, more administrative inquires from providers and patients.

Management Tips

This standard is anomalous because it uses business days, not calendar days, as its metric. This makes sense, however, since it covers only administrative communications, not communications covered elsewhere in the standards (especially requests for review determinations), and because the standard emphasizes that communications should take place during reasonable and normal business hours.

The key here is to articulate clearly in your P&Ps all the various ways you receive administrative requests, what mechanisms are in place to receive them after hours, and that you’ll respond within one business day during business hours. 

You have some flexibility in defining whether you'll respond via telephone or other electronic methods.  Just make sure your P&P is clear on this point.

URAC Accreditation Tips

This standard is weighted 4.  The first element is primary, while the other two are secondary.

The documentation to be submitted for this standard at the AccreditNet phase is merely the applicable P&Ps.  During the onsite review, the reviewer not only will talk to your staff members about their understanding of the communications requirements, but also observe them in action at their desks.  

The applications we’ve seen more frequently leave out the “after hours” component of the P&Ps more than anything else, so don’t overlook it!