URAC UM -- 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 Utilization Management (v. 5.1) module are:

HUM - 9 - Pre-Review Screening Non-Certifications
HUM - 10 - Initial Clinical Reviewer Qualifications
HUM - 12 - Initial Clinical Reviewer Non-Certifications
HUM - 13 - Peer Clinical Review Cases
HUM - 14 - Peer Clinical Reviewer Qualifications
HUM - 22 - Written Notice of Non-Certification Decisions and Rationale
HUM - 30 - Non-Certification Appeals Process
HUM - 31 - Appeals Process
HUM - 32 - Appeal Peer Reviewer Qualifications
HUM - 33 - Expedited Appeals Process Timeframe

Naturally, an applicant for HUM also will have to meet all the mandatory standards for Core, v. 2.1, posted here.