What type of evidence is referred to in Core 35(d)?
Response: URAC review staff will look for reports showing summary data on complaints and an analysis of the organization’s average response time as compared to the timeline it has set for resolving and responding to complaints. During the onsite review, complaint records will be reviewed and more granular reporting analyzed against summary reports. Staff and management will be interviewed to verify their understanding of the complaint process, the organization’s specified time frame for a response, and that an analysis of the complaints is forwarded to the quality management committee.
