URAC Accreditation: What does it mean?

In the late 1980s, there were no existing uniform standards for utilization review services, raising concern within the industry and highlighting a need for oversight. The Utilization Review Accreditation Commission was incorporated in 1990 to offer health organizations an opportunity to have trained reviewers examine their operations and publicly ensure they are delivering care in a manner consistent with national standards. URAC accreditation is a way for a health care organization to demonstrate and highlight their commitment to UR quality and accountability.

The commission was established with the clear intention of remaining apart and independent of any industry interests or specific stakeholder groups. In addition, the board of directors was intentionally constructed to include representatives from the full range of relevant constituencies: health care consumers, providers, employers, regulators, and industry experts.

In 1996, the name was shortened to URAC when the commission began accrediting other organizations including health plans, pharmacies, and providers. Health care groups that can now earn URAC accreditation include health plans (HMOs and PPOs), health care management organizations (disease management, case management, patient-centered medical homes, health call centers, independent review organizations, etc.), health websites and telehealth operations. A complete list of URAC-accredited organizations can be found in the Directory of Accredited Companies.

The URAC Accreditation Process

URAC accreditation is a voluntary undertaking that requires reaccreditation every three years. The entire initial process can take up to 12 months or more and consists of a meticulous four-part review:

• Phase one of accreditation begins with building the application, during which an organization completes the required application forms and submits the base fee.
• Phase two, called the desktop review, involves a team of URAC reviewers who examine submitted documents including those related to policies and procedures. Applicants often have to supply additional documentation at this stage in order to clarify any questions or pending issues.
• Phase three is an on-site review that brings the same accreditation review team face-to-face with the organization’s management and staff. The reviewers may conduct audits, analyze personnel and credentialing files, and review quality management programs.
• Phase four is the committee review, conducted by URAC’s Accreditation and Executive Committees, the group that will ultimately be responsible for delivering a decision for or against accreditation.

“It was a huge milestone for us when we first received our URAC accreditation, and we are dedicated to exceeding these standards and being a leading URAC accredited company,” states Dr. Lousine Alpern, VP of Clinical Services for Advanced Medical Reviews (AMR), “AMR provides quality Independent Medical Reviews and UR services and this is just one way that we accomplish this task.”

URAC Resources

Today, URAC provides more than 30 accreditation and certification benchmarking products. Educational offerings include workshops, conferences, webinars, and audio conferences open to individuals and companies within the health care industry. These programs cover best practices in URAC accreditation and news on health care issues presented by industry professionals and URAC staff.

The organization’s publications, including white papers, newsletters, issue briefs, on-demand media and accreditation guides, are all available online. These resources provide timely and useful information for consumers such as a free online course on understanding health insurance and a health care communication “toolkit,” offering tip sheets on accessing quality care. A section for policymakers includes updates on cost-saving measures, details regarding compliance with state and federal regulations and government relations briefs.