The Accreditation Process
Organizations applying for accreditation participate in a process that entails a rigorous review occurring in four phases. The initial phase "Building the Application", which consists of completing the application forms and supplying supporting documentation, usually takes several months. Once the application and base fee are received by URAC, the remaining three phases of the accreditation process cover a period of approximately three to six months. These phases include the following:
1. Desktop Review. In the desktop review process, the applicant's documentation is analyzed in relation to the URAC standards by one or more full-time URAC reviewers. The applicant's documentation usually consists of, but is not limited to, formal policies and procedures, organizational charts, position descriptions, contracts, sample template letters, and program descriptions and plans for departments such as quality management and credentialing. After receiving a desktop review summary, the applicant usually must provide additional documentation clarifying any pending issues.
2. Onsite Review. After the desktop review is complete, the accreditation review team conducts an onsite review to verify compliance with the standards. During this review, carried out by the same team that performed the desktop review, management is interviewed about the organization's programs and staff is observed performing its duties. In addition, audits are conducted and personnel and credentialing files analyzed. Education and quality management programs are reviewed in detail as well. During the onsite visit, URAC reviewers also share "best practices" and provide other helpful guidance.
3.
Committee Review. The last phase in the accreditation
process is a review by two URAC committees that include professionals
from a variety of areas in health care as well as industry
experts selected from or chosen by URAC's member organizations.
The committee review process begins with a written summary
documenting the findings of the desktop and onsite reviews.
This summary is submitted to URAC's Accreditation Committee
for evaluation with discussion with the review team as needed.
An accreditation recommendation is then forwarded to URAC's
Executive Committee, which has the authority to grant accreditation.
After reviewing the summary and considering the Accreditation
Committee's recommendation, the Executive Committee makes a
final accreditation determination.
Accreditation Status
Applicants who successfully meet all requirements are awarded a
Full two-year accreditation, and an accreditation certificate is
issued to each company site that participated in the accreditation
review.
Conditional accreditations may be awarded to applicants who have appropriate documentation, but incomplete implementation of certain policies and procedures.
Provisional accreditation may also be awarded to companies determined to be "start-ups", e.g., those that have not yet implemented their program or have not had at least six months of operational experience at the time of the onsite review.
Organizations that are unable to meet URAC standards may be placed on corrective action status, denied accreditation, or choose to withdraw.
Follow-up
activities for organizations receiving Conditional or Provisional
status or corrective action may include submission of additional
or revised documentation and another onsite review. When these follow-up
activities are complete, a follow-up executive summary is submitted
to URAC's committees for a possible change to Full accreditation.
Accreditation
Certificates
A certificate of accreditation is awarded to accredited organizations, attesting
to the program the organization is accredited for. Each accredited site is
given its own certificate. This will help the applicant differentiate its various
products in the health care market and target a variety of current and potential
clients. Accredited organizations also provide copies of accreditation certificates
to regulators in states where URAC accreditation is deemed.
Ongoing Compliance with the Standards
Accredited organizations must continue to remain in compliance with the applicable
standards throughout the accreditation cycle. If an accredited company is unable
to comply with URAC Standards, its accreditation will likely be rescinded.
Complaints against
an Accredited Company
URAC has a grievance procedure for investigation of complaints about an accredited
company. Complaints may originate from consumers, providers or regulators.
After an investigation of each complaint, which may or may not include an onsite
visit, URAC may sanction an accredited company. Sanctions may range from a
letter of reprimand to revocation of accreditation, depending on the nature
and frequency of the violations.
Accreditation Cycle and Reaccreditation
URAC accreditation is granted for two years starting the first day of the month
following URAC's Executive Committee approval. Accredited companies seeking
reaccreditation must submit the reaccreditation application to URAC at least
four months before the accreditation expiration date or six months prior to
expiration if the accredited company is a network reapplying for Health Plan
or Health Network accreditation.
Web Site
Accreditation Process
The Web site accreditation process has some notable differences from the other accreditation programs. The application process is divided into two distinct phases: 1) the pre-application, and 2) the formal application. URAC first requires applicants to submit a “pre-applications” including payment information and general information about the company and it’s Web site. Once the pre-pay is processed, URAC will initiate the formal application process.
URAC will send the primary contact person a letter and/or email confirming receipt of the pre-application. The letter of receipt will include confidential access codes assigned to the applicant that are used to access the secure, online formal application which contains questions specifically related to the Standards. Once completed, the formal application will be assigned to an Accreditation Reviewer.
The Accreditation Reviewer will follow the formal application through the accreditation process and is the same reviewer who will conduct all activities associated with the review process -- desktop review, onsite review, and presentation of the application to the URAC committees. Unlike other URAC accreditation programs, onsite visits are not "required" during the application process and a telephone interview of corporate officials is conducted instead. In certain circumstances, URAC reserves the right to conduct an onsite review if the telephone interview and formal application are inconclusive.
URAC's model of performing accreditation reviews allows the Accreditation Reviewers to develop an in-depth knowledge of the organization under review and provides a mechanism for the applicant to receive on-going feedback regarding the application and review findings.