The Basics

This standard sets forth the requirements for onsite UM reviews, typically falling in the category of concurrent reviews.  It is designed to smooth the relationship between the facility and the UM organization by requiring that the reviewer:

• wear a photo ID badge (including the name of both the reviewer and the organization);
• either schedule the review a day in advance or have some other arrangement with the facility; and
• follow any reasonable procedures required by the facility (such as checking in upon arrival).  

Management Tips

As usual, the key documentation here for desktop review is a policy and procedure that requires all of what is required by the standard.

There are a couple of ways to meet the photo ID requirement.  The most obvious is for the organization to issue a photo ID that meets this requirement.  However, if the only photo ID is a driver's license, it will suffice so long as the reviewer also carries an organizational ID that has both the person's and the organization's name.

What if you don't conduct onsite reviews?  In that case, make sure your UM program document (often called a UM Program Description) specifies that the program does not include onsite reviews.  In the absence of such documentation, you may need to submit an attestation that onsite reviews are not a part of your UM function.

URAC Accreditation Tips

This standard carries a weight of 3, and all of the elements are secondary.

The documentation to be submitted for AccreditNet should include the applicable P&P and, if applicable, an example of any documentation of special onsite review arrangements you have with particular facilities.

If you have a particular arrangement with one or more facilities describing the terms and conditions of the review visits, documentation of that arrangement also should be submitted with the application.  

The onsite review also will involve the examination of any special facility agreements as well as interviews -- perhaps by telephone -- of members of the concurrent review staff.