The Basics

This standard sets for the minimum requirements for your appeals records:

• Patient name
• Name of provider and/or facility rendering service
• Copies of all patient correspondence
• Copies of all provider/facility correspondence
• Actions taken and the dates they were taken, including decisions, correspondence, and resolution
• Minutes from any appeal proceedings
• The name and credentials of the appeals reviewer for each case

Management Tips

Note that this standard applies not only to the records themselves, but to the Appeals P&P.  In other words, your P&P needs to be explicit about your appeals record-keeping practices.  

URAC goves you flexibility about these records and their storage -- electronic and paper are both fine.  

URAC Accreditation Tips

This standard is weighted 4, and is comprised of both primary and secondary elements.

The Appeals P&P and any logs containing the required information should be submitted for desktop review.

The onsite reviewer will look at your log and your case files to verify compliance with this standard.