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GUIDELINES FOR CRITERIA AND CERTIFICATION RULES
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GUIDELINES FOR
CRITERIA AND
CERTIFICATION RULES ANNEX - JAWDA Data Certification for Healthcare
Providers - Methodology 2017
December 2016
GUIDELINES FOR CRITERIA AND CERTIFICATION RULES
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1. Contents
1. Contents 2
2. General 3
3. Certification Requirements and Guidelines for Criteria 4
4. Weights and Scoring 9
5. Annual Certification 11
6. Maintaining Validity of the Certificate 11
7. Performance of Audits 12
8. Management of Certificates 13
9. Modification of Certification and Communication of Changes 13
10. Special Requirements for Multi-Site Facilities 13
11. Suspension, Reinstatement and Withdrawal of Certification 14
12. Renunciation of Certification 14
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2. General
2.1 These rules constitute integrate the Contract between certification body (TASNEEF) and Healthcare
Facilities. These Rules don’t replace the Methodology 2017 but are part of the contractual requirements to
achieve the JAWDA Data Certification. In this perspective, the rules describe identify criteria the Facilities can
or must apply for the JAWDA Data Certification related to the HAAD Methodology 2017 and how facilities can
apply for obtain, retain, renew and use this certification, as well as its possible suspension and revocation.
2.2 Certification is in accordance with HAAD Methodology dated December 2016 to facilities where
Management System must be recognised as conforming. The Criteria of the certification are represented from
the Methodology and other requirements of the compulsory reference standards or guidelines described in
this document.
2.3 Certification is open to all Healthcare facilities in Abu Dhabi belonging to the following categories and
encounters:
Hospitals
Medical Centres /Clinics
TASNEEF is entitled to refuse requests for certification by facilities whose activities have been subject to
restriction, suspension or proscription by a public authority.
When TASNEEF declines an application, the reasons shall be communicated to HAAD and the facility
CFO/CEO/COO or delegated authority.
2.4 This document provides also guideline to the Criteria applicable to the certification process because the
JAWDA Data Certification is oriented to improve quality in the healthcare facilities.
Quality means the ability to satisfy requirements of moral, material, social and economic nature,
translated into stated requirements.
The quality of the health service (intended as the ability to satisfy the associated needs) is the result of a:
series of scientific, technical and technological, organizational, procedural, relational and
communicational elements in which a determining role is carried on by the human variables
(health operators and service customers – in this concept is patients) that strongly interact in the
realization processes, even more than in other activities also essentially based on human
relations, such as education
The elements to be considered in quality in health and associated achievement services are therefore
numerous and complex for example through:
adequate organization of the structure and suitable management of the primary and supporting
services, which are reflected, though not strictly, in the ISO 9000 and JCI series;
adequate definition of the "technical" content of the services provided (service specifications),
which corresponds to a series of specialized standard references of which medical-scientific
documentation and diagnostic-therapeutic protocols are particularly important;
qualification of assigned personnel (basic training, applicative knowledge, human skills and ethics
behavior), which is related to the mechanisms of recruitment, selection, training;
medical-scientific reference documentation (Protocols, Procedures or Instructions, etc.) that are
used to support the records.
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2.5 The JAWDA Date Certificate issued pertains exclusively to a single healthcare facility identified by their
license number.
3. Certification Requirements and Guidelines for Criteria
3.1 JAWDA Data Certification
HAAD defines two key elements to quality in healthcare – Reliability and Excellence:
Reliability
The systematic reduction in errors or untoward events defined in HAAD Standards
Monitoring through self-checking or audits and inspections by HAAD or by bodies on its behalf.
Excellence
The continuous improvement, beyond minimum Standards, of clinical care delivery, customer
satisfaction and cost-effectiveness.
Underpinned by the routine collection, analysis and use of health data for routine clinical audit by
Providers (and Departments) and Professionals.
Driven towards continuous improvement through a clear “pay for quality” incentive system
intention of improving clinical data quality thereby improving quality of patient care.
To obtain JAWDA Data Certification the facility must:
Have established a Management System and kept it active in total conformity with the requirements of
the HAAD Methodology 2017.
The management system is considered as being fully operative when processes, checkpoints and
documented information are established for the three domains of certification as per below:
Claim review
Clinical Coding Process Review
“KPI” Data Validation (relevant to Quality Indicators Data Submission and applicable only for
hospitals)
“KPI” Process Review (relevant to Quality Indicators Data Submission and applicable only for
hospitals)
3.2 Claims Review
Claims Review is one of the four components of the JAWDA Data Certification. Claims review is a validation
process to review physician documentation against the submission of reported clinical coded data by all
healthcare providers to build trust between payers and providers.
JAWDA Data Certification will endeavor to strengthen the trust between payers and providers by:
Creating a shared understanding of the facility’s coding and physician documentation quality
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Giving the payers confidence that a facility is coding and documenting accurately
Providing the facility with recommendations to improve the quality of coding processes
This involves the comparison of actual coding practices against agreed, documented, evidence based
standards with the intention of improving clinical coding data quality thereby improving quality of patient care.
The purpose of the claim review is to measure the medical record:
to verify documented services provided to the patient,
to verify the documented information describing the course of the patient’s condition and
treatment and
to verify the validity of billable services
3.2.1 Applicability
Claims Review will be a mandatory requirement for all the healthcare facilities contracted with health
insurance companies for providing healthcare services, including the lowest Evaluation and Management level
of service
3.2.2 Criteria (reference standards, methodologies, single standard’s requirements):
HAAD JAWDA Data Certification Methodology 2017 (compulsory)
CPT 4th Edition procedure (compulsory)
ICD-9-CM Official Guidelines for Coding and Reporting (compulsory)
ICD-9-CM Coding Manual for Hospitals & Other Healthcare Institutions, published by Health
Authority- Abu Dhabi (Refer to: Appendix A) (compulsory)
ICD-10-CM Official Guidelines for Coding and Reporting (compulsory if applicable)
HAAD CLAIMS & ADJUDICATION RULES V2012 and Appendices
3.2.3 Audit checkpoints
Claim level audit on random samples as per the guidelines mentioned in the methodology. The audit will focus
on scoring:
a. Accuracy (ICD-9-CM, ICD-10-CM, CPT 4th Edition for all services)
b. Completeness ((ICD-9-CM, ICD-10-CM, CPT 4th Edition for all services)
3.2.4 Accuracy claims review will output an Accuracy Score by assignment and reporting of only the codes and
data that are clearly and consistently supported by the health record documentation and in accordance with
applicable code set and abstraction conventions, rules, and guidelines. Claims reviews will also identify clinical
coding submission or improper documentation practices intended to inappropriately increase reimbursement
from payers or influence payer adjudication rules.
Completeness analysis contributes to recommendations on claims coding practices and does not affect the
passing criteria. It includes missing diagnoses and procedures that would have provided more detail on the
condition or status of the patient but would not have an impact of higher outcome of reimbursement from
payer for the services provided.
The Completeness scoring will help determine and/or recommend improvements with regards to the reporting
of clinical coding and/or deficiencies in physician documentation.
Once each medical record has been scored, a mean average score will be calculated for each place of service.
(E.g. Inpatients-DRG, Day-case, Outpatient clinics, Emergency and Home Care).
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3.3 Clinical Coding Process Review
Successful processes should be understood and followed by all involved. The facility will be rated on the
facility’s understanding and adherence to their process. The process of adherence check is to understand the
deficiencies in the Management System.
3.3.1 Applicability
Clinical Coding Process Review will be a mandatory requirement for all the healthcare facilities contracted with
health insurance companies for providing healthcare services, including the lowest Evaluation and
Management level of service.
3.3.2 Criteria (reference standards, methodologies, single standard’s requirements):
HAAD JAWDA Data Certification Methodology 2017 (compulsory)
HAAD Coding Manual for Hospitals & Other Healthcare Institutions (compulsory)
HAAD CLAIMS & ADJUDICATION RULES V2012 and Appendices
American Medical Association (AMA) (compulsory)
Centers for Medicare & Medicaid Services (CMS) manual system
WHO Medical record standards
Electronic Code of Federal Regulations
American Health Information Management System (AHIMA)- Body of Knowledge
American Hospital Association (AHA) Coding Clinics (compulsory when applicable)
HAAD Providers Policy Manual
ASTM E1869-04(2014) Standard Guide for Confidentiality, Privacy, Access, and Data Security Principles for Health Information Including Electronic Health Records
ASTM E2017 - 99(2010) Standard Guide for Amendments to Health Information
ISO 9001:2015(paragraphs 7.2, 7.5, 8.0 in relation to the validation concept, 9.0, 1
Joint Commission - International Accreditations Standards for the Hospitals 5th Edition
(Healthcare Organization Management Standards ‘QPS series’ and Management of Information –
‘MOI. Series’)
3.3.3 Audit checkpoints
Facility will be audited against the following aspects and utilizing the compulsory criteria or suggested or
equivalent:
Coding Process Flow chart reflecting the process followed in the facility
Policies review - such as Coding Practice Policies, Healthcare Documentation policies
Coder Credentials and Continuous education validation
Orientation or Training policy
Level of Implementation of policies through four departments
3.3.4 Mandatory Certified Coder
One of the following criteria must be met to pass the JAWDA Data Certification audit:
have a Certified Coder with active status of AAPC or AHIMA (or) evidence of contracted
outsourcing for coding services
Action plan to train and certify a coder within the facility in a specific time (maximum 1 year)
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The process review will include:
Gaps or deficiencies in the data submission process flow
Record of Coder certification validation based on submitted proofs
Creation and updating of processes, policies relevant to clinical coding
Review of Compliance practices for coding
Review of control and modification of documents
Adherence check and provide with the areas for improvement, and recommended trainings
Identified non-conformities to policies and process flow
3.4 KPI Validation for Collection and Submission of Quality Indicators
The vision for the Health System in Abu Dhabi is to provide access to high quality healthcare services to all. To
achieve the vision a common language was developed and a standardized way of exchanging data.
KPI validation is a method to verify if the information collected from the Hospitals for HAAD Quality
Performance KPI Profile program has an objective evidence to confirm that the requirements which define the
intended use have been met.
As healthcare moves forward with initiatives such as quality-driven reimbursement and clinical quality
measure reporting, both organizations and physicians must provide justification for patient care and
demonstrate quality outcomes.
3.4.1 Applicability
Only for hospitals registered from the Health Authority in the JAWDA Program for Quality Indicators and
metrics.
3.4.2 Criteria (reference standards, methodologies, single standards’ requirements):
HAAD JAWDA Data Certification Methodology 2017 (compulsory)
Waiting time indicators from JAWDA program (compulsory)
ISO 9001:2015 (paragraphs 7.2, 7.5, 8.0 in relation to the validation concept, 9.0, 10.0)
HAAD reference Quality Performance KPI Profile - Dec. 2015 (compulsory)
HAAD reference. Per Circular CEO 38/ 12 (compulsory)
Joint Commission - International Accreditations Standards for the Hospitals 5th Edition
(Healthcare Organization Management Standards ‘QPS series’ and Management of Information –
‘MOI. Series’)
3.4.3 Audit Checkpoint
The validity will check against matching of results submitted. The validation may undertake one or all the category of established indicators (e.g. waiting time indicators, adverse incidents and outside critical care cardiac arrest). Certification body will verify the validity and on time submitted data. The validation will match the internal reports of the facility against the reports sent to HAAD. Mystery shopping could be performed from the certification body to validate the reports. Every year HAAD will define the scope of KPI Validation including or excluding indicators.
3.5 Process Review for: “KPI” Quality Indicators (applicable only to Hospitals)
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The aim of this quality measure is to improve the validity of KPI data collection and submission processes. This
will add an extra layer of prioritization for the quality at the healthcare providers’ level. Patient safety, clinical
effectiveness and patient experience are recognized as the main pillars of quality in healthcare. Healthcare
providers will be evaluated on processes in planning for data collection and submission.
The process approach is the most relevant aspect of any quality system. The Abu Dhabi Health Authority
orients its methodology to it for better control of any healthcare outcome.
A process is a set of activities that are interrelated or that interact with one another.
Processes use resources to transform inputs into outputs.
Processes are interconnected because the output from one process often becomes the input for another
process.
Organizational processes should be planned and carried out under controlled conditions. An effective process
is one that realizes planned activities and achieves planned results (e.g. as per the ISO 9001:2015 concept).
3.5.1 Applicability
Only for hospitals registered from the Health Authority in the JAWDA Program for Quality Indicators.
3.5.2 Criteria (reference standards, methodologies, single standard’s requirements):
HAAD Methodology 2017 (compulsory)
Waiting time indicators from JAWDA program (compulsory)
ISO 9001:2015 (paragraphs 7.2, 7.5, 8.0 in relation to the validation concept, 9.0, 10.0)
HAAD reference Quality Performance KPI Profile - Dec. 2015 (compulsory)
HAAD reference. Per Circular CEO 38/ 12 (compulsory)
3.5.3 Audit Checkpoints
The facility must make all necessary information available to TASNEEF for KPI planning for data collection and
submission. The following to be considered:
Robustness:
Quality Lead
KPI Process Awareness
Data Collection Plan
Data Collection Tools
Data Collection Methodology
Data Submission Process and Timeliness
Data Integrity and Backup plan
Data collection trails (Audit trails)
Communication log for feedbacks and performance improvements
Submission Log
Quality Governance:
Regular quality monitoring system
Staff Awareness of quality governance, data collection, improvement
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Risk management process to control risks that could prevent the organization’s achievement to the planned objectives
Customer complaints process management Internal Audits and Non-conformance processes
Structural management review process to review the performance of overall quality system
4. Weights and Scoring The final score will be weighted per the facility type as shown in the below tables. The passing scores for
process review of clinical coding, process review for KPI and KPI data validation will be communicated
annually from HAAD.
Facility Type: Medical Centers / Clinics - Table 4.1
Facility Type: Hospitals Table 4.2
Facility
TypeDomain Domain details Weights
Score Points
Final
weights
Final
Score
Outpatient - 100 20% 90 18.00
Emergency - 100 20% 88 17.60
Inpatient - 100 20% 88 17.60
Day case - 100 20% 88 17.60
Home Health care- 100 20% 88 17.60
88.40 60.00 53.04
Process flow Map - 20 15 15.00
Clinical Coding Policies Review - 30 20 20.00
Coder Credentials - 10 5 5.00
Orientation/Training - 20 15 15.00
Compliance-4 departments - 20 15 15.00
70.00 20.00 14
Robustness 50% 40 40.00
Quality Governance 50% 30 30.00
70.00 15.00 0
KPI Data Validation
Score - 100 Data Validation (9-Indicators-WT)100%
88 88.00 5.00 4.4
71.44
HOSPITALS -DETAILED SCORING
Hospitals
Claims Review
Claims review Score - 100
Clinical Coding
Process Review
Clinical Coding Process Review Score - 100
KPI Process review
KPI Process review Score - 100
FINAL JAWDA CERTIFICATION SCORE
Facility
TypeDomain Domain Details Weights
Final
weights
Over all
weights
Outpatient (100) 50%
Day case* (100) 50%
Claims review Score for 100 80% 80%
Process flow map (15) 15%
Coding Policies (5+35) 40%
Coder Credentials (20) 20%
Orientation/Training (5) 5%
Compliance-4 departments (20) 20%
20% 20%
CENTERS / CLINICS -DETAILED SCORING WEIGHTS
Medical
Centers
/Clinics
/Home
care
centers
Claims Review
Clinical Coding
Process
Review
Clinical Coding Process Review Score for 100
FINAL JAWDA CERTIFICATION SCORE
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Example1: Details of scoring for the medical centers and clinics will be as shown in the below table as an example:
Table 4.3
Example 2: Details of scoring for the Hospitals will include KPI Indicators validation along with Clinical Coding as shown in the below table as an
example:
Table 4.4
Facility Type Domain Domain Details Weights Score Points Over all weights Final Score
Outpatient (100) 50% 86 43.00
Day case (100) 50% 86 43.00
Claims review Score for 100 86.00 80% 69%
Process flow map (15) 15% 15 15.00
Coding Policies (5+35) 40% 30 30.00
Coder Credentials (20) 20% 15 15.00
Orientation/Training (5) 5% 5 5.00
Compliance-4 departments (20) 20% 20 20.00
85.00 20% 17%
86%
CENTERS / CLINICS -DETAILED SCORING
Medical
Centers
/Clinics/
Home care
Centers
Claims Review
Clinical Coding
Process
Review
Clinical Coding Process Review Score for 100
FINAL JAWDA CERTIFICATION SCORE
Facility
TypeDomain Domain details Weights Score Points
Over all
weightsFinal Score
Outpatient - 100 20% 90 18.00
Emergency - 100 20% 88 17.60
Inpatient - 100 20% 88 17.60
Day case - 100 20% 88 17.60
Home Health care- 100 20% 88 17.60
88.40 60.00 53.04
Process flow Map - 20 15 15.00
Clinical Coding Policies Review - 30 20 20.00
Coder Credentials - 10 5 5.00
Orientation/Training - 20 15 15.00
Compliance-4 departments - 20 15 15.00
70.00 20.00 14.00
Robustness 50% 40 40.00
Quality Governance 50% 30 30.00
70.00 15.00 0.00
KPI Data Validation
Score - 100 Data Validation (9-Indicators-WT)100%
88 88.00 5.00 4.40
71.44
HOSPITALS -DETAILED SCORING
Hospitals
Claims Review
Claims review Score - 100
Clinical Coding
Process Review
Clinical Coding Process Review Score - 100
KPI Process review
KPI Process review Score - 100
FINAL JAWDA CERTIFICATION SCORE
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5. Annual Certification Facilities wishing to obtain certification for their JAWDA must provide TASNEEF with their main facility
data and site location by filling in all parts of the “APPLICATION FORM” on TASNEEF website at
www.tasneefba.ae/ccc
The APPLICATION FORM requires information to be provided on:
Name of the Facility
HAAD License No.
Facility Settings
Contact Details
Other mandatory fields
This information should be provided by an authorized representative of the applicant organization.
5.1 Contract formation
o TASNEEF will open file with the provided information and prepares a suitable contract
as per the Tier system applicable to the facility, which is provided by HAAD, and
contract will be sent to the authorized representative for certification.
Prior to performing the audit, TASNEEF makes sure:
a) there is sufficient information concerning the applicant facility and its management system to perform the audit;
b) certification scope is clearly established and documented and are sent to the applicant facility;
c) every difference of interpretation between TASNEEF and the applicant facility has been eliminated;
Acceptance of the contract is made by sending TASNEEF the specific form attached to the contract and any
other document per which certification is requested.
On receipt of the application for certification and the relative annexes and having ensured they are
complete, TASNEEF will send the facility written acceptance of its application.
The agreement signed between TASNEEF and the facility includes:
1) Certification fee
2) Information on fee for Follow-up Audits if applicable to the facility as mentioned in the contract and as per the applicable General terms and Conditions
3) After the satisfactory completion of the initial audit and after validation by TASNEEF, a Certificate of Conformity with the reference standard, if meet the criteria, will be issued.
6. Maintaining Validity of the Certificate The facility must ensure its System continues to comply with the Methodologies and other applicable
reference standards or regulatory document. The facility must record any complaints / claims and the
relative corrective action implemented and must make these records available together with the
corrective action taken to address the identified deviations.
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TASNEEF also reserves the right to perform additional audits based on the impact of identified deviations
in the processes. Also, reserves the right to perform and charge Re-audits on failed facilities.
May conduct a follow-up audit to confirm that the major deviations identified during the initial audit have been corrected by facility as per the action plan. Action plan should be sent by the facility to TASNEEF giving the details of action for corrections with-in a week after initial audit.
TASNEEF shall conduct a Re-audit on failed facilities as Phase-1 audit to verify the corrected Processes as per the action plan within two months’ duration after failure.
A mandatory uninformed or surprise audit on Claims review will be done on the failed facilities after completion of first phase of Re-audit with-in six months’ from Phase-I.
If the facility refuses without a justified reason, TASNEEF may decide to suspend/withdraw certification.
7. Performance of Audits
7.1 General
An “Audit Plan” is drawn up for each audit according which is sent to the customer facility in good time.
TASNEEF also uses the Audit Plan to inform the Facility of the names of the auditors and technical experts
appointed to perform the audit, chosen based on the skills required to perform the audit; the Facility may
object to the appointment of these auditors provided it gives a justified reason, for example regarding
conflict of interests.
The audit has the following objectives:
a) Determination of the conformity of the client’s management systems, or part of it, with audit criteria;
b) Evaluation of the ability of the management system to ensure the client organization meets applicable and contractual requirements;
NOTE: JAWDA Data Certification audit is not a legal compliance audit.
c) As applicable, identification of areas for potential improvement of the management system.
The Audit Plan indicates the tasks assigned to each auditor. Specifically, for each facility:
a) the structure, policy, processes, records and relative documents to the applicable Management system must be examined and checked;
b) it must be established whether these satisfy the requirements applicable to the scope of certification;
c) it must be established whether the processes and documented information are drawn up, implemented and kept efficient, to nurture trust in the Facility's management system;
d) every inconsistency between the organization or facility’s policy, objectives, goals and the result obtained must be reported to the facility (authorized representative) to allow for appropriate action.
e) Collecting audit evidences
7.2 Report
A copy of the written report will be delivered to the authorized representative, responsible for the facility.
The original audit report is owned by the certification body.
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The facility may indicate any reservations or comments concerning the findings by the TASNEEF auditors in
the relative space in the audit report.
The report will include:
Scoring for claims review
Scoring for Process Review – Clinical Coding
Scoring for Process Review – KPI (applicable only to Hospitals in JAWDA program)
Scoring for KPI data validation (applicable only to Hospitals in JAWDA program)
Recommendations for improvements
After analyzing the reasons for any major or minor observations indicated in the above report, the Facility
must, within the data indicated on the report, inform TASNEEF of its proposals for handling the
observations, as well as the corrective action required and the dates envisaged for its implementation.
In the event of major observations (type A findings) the certification process requires an extra visit for
process review; this follow-up audit must be performed within two months to check the effectiveness of
the proposed corrective actions; if this audit is successful the certification process will be resumed.
The auditing team may decide to perform any follow-up audit on site or on the documents, depending on
the type of corrective action involved.
All costs relative to any follow-up audit deriving from shortcomings in the Management System will be
charged to the facility.
8. Management of Certificates 1. The validity of the certificate is based on the scoring achieved by the facility
2. The validity of the certificate, could be subjected to the results of the subsequent audits.
3. The validity of the certificate may be suspended, withdrawn or relinquished
9. Modification of Certification and Communication of Changes
9.1 The facility must promptly inform TASNEEF of any changes in factors that may affect the capacity of the
Management System to continue to satisfy the requirements of JAWDA Data Certification.
These requirements concern, for example, modifications to the legal, commercial, facility or ownership
status.
TASNEEF reserves the right to perform additional audits on the facility if the modifications communicated
are considered particularly significant in regards maintaining the conformity of the Management System
with the requirements of the reference standard and of these rules or to review the economic conditions
for the possible modification of the contract.
9.2 TASNEEF promptly informs the facility of every change in the methodology, reference standards or
certification rules.
10. Special Requirements for Multi-Site Facilities If a provider operates on more than one facility and a single contract is required, audit activities will be
performed for each facility anyway;
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Note: in case of centralised system, the auditor will verify if all facilities are following same methods and procedures.
11. Suspension, Reinstatement and Withdrawal of Certification The validity of the certificate of conformity may be suspended as indicated in “GENERAL TERMS AND
CONDITIONS” and in the following specific cases:
if the Facility refuses to allow the scheduled audits to be performed at the required frequencies;
if observations are found in the management system which have not been corrected within the time limits established by TASNEEF
if the facility does not observe the deadlines established for the communication of corrective actions, following observations/observations indicated on the audit report;
for evidence that the facility does not guarantee the respect of the laws and regulations applicable to the supplied services or activity
if any justified and serious claims received by TASNEEF are confirmed.
The facility may also make a justified request to suspend certification, normally for not more than six
months and in no case after the date of expiry of the certificate.
This suspension will be notified in writing, stating the conditions for re-instating certification and the date
by which the new conditions are to be complied with.
Revocation of the certificate of conformity may be decided in the following specific cases:
if the facility does not accept the economic conditions established by TASNEEF due to a modification in the contract tariff, approved with HAAD
for every other major reason, at TASNEEF 's discretion, such as the proven incapacity of the system to pursue its objectives of complying with legislative, contractual requirements.
Withdrawal of the Certificate of Conformity is notified in writing to the Facility and made public in HAAD
website
Any facility which, following revocation of its Certificate, wishes to be re-certified, must submit a new
application and follow the entire procedure all over again.
12. Renunciation of Certification
A certified facility may send formal communication of renunciation of certification to TASNEEF in case of
business termination, before the expiry of the certificate.
Upon receipt of this communication, TASNEEF starts the procedure for invalidating the Certificate.
Within one month from the date of the communication, TASNEEF updates the validity status of the
certificate.
