URAC Announces Revised Standards for Five Accreditation Programs

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Updated Standards Provide Greater Consumer Protection

URAC, a leading health care accreditation and education organization, announced revisions to five (5) of its Health Care Management and Operations Accreditation programs. These revisions, which are part of URAC’s commitment to regular comprehensive review of its standards, have been approved by the URAC Board of Directors and will be released in November 2011.

The revisions to the standards have been made in light of health care reform, addressing the goals of the Patient Protection and Affordable Care Act (PPACA) Part 2: Consumer choices and insurance competition through health benefit exchanges, Sec. 1311: Affordable choices of health benefit plans, and as such address Medical Loss Ratio (MLR) and Mental Health Parity regulations.

The program revisions approved by the Board include:

  •     Health Network, v7.0
  •     Provider Credentialing, v6.0
  •     Health Utilization Management, v7.0
  •     Workers' Compensation Utilization Management, v6.0
  •     Health Plan, v7.0 (previously announced)

URAC’s Health Network standards have been revised to elaborate on the provider relations program, and to provide clarification on the credentialing phase-in process for Health Networks. Additionally, these standards as well as the Provider Credentialing standards now allow for delegation oversight of the credentialing process to occur remotely. Further revisions to the Provider Credentialing program increased patient protection by requiring procedures that prevent a provider from being listed in a provider directory prior to being credentialed. Requirements for primary source verification of licensure were also clarified.

Two new standards have been incorporated into URAC’s Health Utilization Management and Workers’ Compensation Utilization Management programs. The first, Prospective Review Patient Safety, meets the criteria for a quality improvement activity per Medical Loss Ratio regulations. The second, Reviewer Attestation Regarding Credentials and Knowledge, ensures that a reviewer has the requisite background and experience to conduct the review.

Publication of the revised standards, including the accreditation guides and crosswalks to previous versions, will be available in November 2011.

For more information about these revised standards please contact business.development(at)urac(dot)org or go to http://www.urac.org.

About URAC
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit http://www.urac.org.

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Jessica Lutz
URAC
(202) 326-3967
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