The largest online database anywhere of free accreditation advice for frontline and management employees in healthcare.
For well over a decade, we've been gathering what we know about accreditation standards and putting that knowledge into plain language. The product of those years of study and writing is this database of accreditation tips. Whenever we learn something new about a standard or the way the reviewers are interpreting it, we update our database.
Search the articles below. Get more accurate results by entering in the standard name or accreditation program.
The standard is for the special situation of a provider whose conduct is so egregious as to give rise to a well-founded concern by your medical director that the provider is posing a threat to the well-being of your members. This is a very important consumer safety standard. Not only must your medical director be freed from the requirement of taking such a dispute through the normal, often slow, d...READ FULL POST
This standard requires that your organization have a mechanism for disputes with providers in your network for largely administrator disputes. Essentially, any provider disputes that are not covered by the previous standard or by the health utilization management appeals standards are covered here.The mechanism that your organization is required to have for such disputes is simply the right to bri...READ FULL POST
This standard outlines the minimum requirements for a particular kind of provider dispute resolution process: those disputes that involve issues related to the provider's professional competence or conduct, or impact the provider's status within the provider network. For such disputes, your organization must provide the following:A first-level appeal, to be held by a panel of no fewer than three p...READ FULL POST
This standard applies to provider dispute resolution policies for both administrative matters and professional conduct or clinical quality matters that affect participation in the network. In both cases, the policies describing the dispute resolution process must:Make it clear that dispute resolution mechanisms are available to all participating providers;Explain how the provider can provider disp...READ FULL POST
The standard requires that your organization implement a means of addressing alleged violations by participating providers in its network of the organization's requirements for providers. The standard applies only to providers already in your network, not merely applicants for participation in the network.READ FULL POST
The standard is intended to address the situation of "silent PPOs". URAC provides the following definition and explanation of silent PPOs:[A] PPO brokers access to its provider network to other PPOs or payers without providers’ knowledge. For example, PPO X may sell access to its provider network to PPO Y. When an eligible person from PPO Y receives service from a physician in PPO X’s network, PP...READ FULL POST
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