What Steps Does the Accreditation Process Include? In order to obtain accreditation, a four step process must be completed.

Step 1. Application – A managed care organization completes an application in URAC format to document compliance with case management accreditation standards. The application includes the following documentation: policies and procedures; table of organization; job descriptions; training materials; quality improvement program description and initiatives; and, minutes of committee meetings. Once an application is complete, it is submitted to URAC and assigned to a URAC Accreditation Reviewer.

Step 2. Desk-Top Review – A URAC Accreditation Reviewer completes a thorough review of the application and determines compliance with all case management standards. If application material is insufficient to demonstrate compliance with a particular standard, the reviewer works with the applicant to obtain additional information or make necessary revisions to the application.

Step 3. On-Site Audit/Review – The on-site review is scheduled once the URAC accreditation reviewer has confirmed compliance with all necessary standards. The URAC Accreditation Reviewer then schedules an on-site visit to the organization to confirm they are operating in compliance with all necessary standards. This on-site visit consists of: interviews with key staff members; review of case management files; review of personnel files; review of other documentation such as training manuals, policy and procedure manuals; complaint logs; and, committee meeting minutes, all to verify compliance with applicable standards.

Step 4. URAC Accreditation Committee Review – Once this on-site review is complete, the URAC Accreditation Reviewer makes a recommendation concerning accreditation based on their findings. Recommendations include: Full Accreditation – Award of full accreditation for two years.

Conditional Accreditation – Award of accreditation for one year with a re-visit in 3-6 months to ensure compliance.

In-Process Corrective Action – Additional steps must be taken to demonstrate compliance with standards and a revisit is required within approximately 90 days to verify corrective action has achieved compliance.

Denial – Fails to demonstrate compliance with the standards necessary to obtain accreditation. URAC Accreditation Committee Review If the URAC Accreditation Review Team is satisfied that the organization is in compliance with the standards, then the application is forwarded to the URAC Accreditation Committee for review.

Approval Recommendation – If the URAC recommens approval of the application, it is forwarded to the URAC Executive Committee for final approval. Once accreditation is approved, the organization is notified and the accreditation is effective the first day of the following month.