The world is changing – and that even includes the arcane world of physician board certifications.

Not that many years ago there were but a few options:

• American Board of Medical Specialties (ABMS) and
• American Osteopathic Association (AOA)

URAC cited these physician board certifications in its standards given their reputation as gold standard benchmarks for medical physician board certification credentials. More recently, however, additional physician board certifications have become available. Instead of dodging this politically-charged issue, to its credit the July 2015 URAC Board reviewed the matter. They concluded to uphold URAC’s long-standing policy to recognize government regulatory requirements and oversight when it either supersedes URAC requirements when they are more stringent, or when they result in a clear benefit to the healthcare consumer.

This decision precipitated changes to the standards to better reflect the policy. In programs that address utilization review appeals (e.g., Health UM, Workers’ Comp UM, and Health Plan), specific reference in the standards to the ABMS and AOA were removed; however, changes to the IRO standards were more recently approved by the April URAC Board and will be implemented starting July 1^st. To demonstrate compliance, applicant organizations will need to show:

• Documentation of state medical board or other applicable state or federal government entity acceptance of physician board certifications.
• If, as a matter of policy, the government entity does not formally recognize physician board certifications, or, has not addressed a specific board certification, the organization documents the decision made by its physician clinical leadership.
• Credentialing plan or credentialing policies and procedures are updated as needed to reflect the accepted physician board certifications.
• Procedures indicate what to do when staff comes across a physician board certification that is not addressed in the organization’s documentation.

Organizations use physician board certifications to select the best physician to review clinical cases. URAC standards – now clarified – continue to guide organizations responsible for making these important clinical decisions