How Can URAC's Programs and Services Help Consumers?
At URAC, we understand how important it is to have reliable information about your health plan when making a decision of care for you and your family. URAC offers a variety of programs and services that can help you better understand how your health plan coverage is structured and whether your plan meets quality standards.
One of the first things you should do is determine if your health plan, or one of its partners, is URAC-accredited. By doing so, you will know your health plan has passed a rigorous, comprehensive review against national standards for quality health care. By enrolling in an accredited plan, you also are entitled to specific protections that are required in URAC standards. URAC’s online directory at (Online Directory) will help you determine if your health plan is URAC-accredited and for which of the accreditation programs described below.
Here is an overview of the major health plan functions that could be accredited or certified:
Core Operations.
Most URAC accreditation programs require that a health plan’s core operations be accredited. These standards ensure that your plan is supervised by appropriate clinically trained staff and that it focuses on consumers rights, such as complaint processes and patient safety.
Network Operations.
Standards to ensure the integrity and accountability of provider networks are embedded in URAC’s Health Plan and Health Network Accreditation standards. For example, your health plan must have signed contracts and credential physicians who provide care. This helps ensure that you receive services from a qualified doctor.
Medical Management.
URAC has a variety of standards that govern how your health plan determines what is medically necessary or not, and how the plan manages your care. Accreditation programs cover:
- Utilization management services
- Case management services
- Disease management programs
- Health Call Center
- Independent (third party) review
Health Web Site Information.
URAC provides oversight on how an accredited health Web site is operated. URAC Health Web Site Accreditation ensures that the site is supervised by clinically trained staff, discloses key information about how the Web site operates, and limits how your personal health information is used or disclosed to third parties. Look for the URAC accreditation seal on health Web sites’ home page.
Privacy & Security.
A new federal law and regulation has been adopted that provides protections to consumers regarding how their personal health information is collected, stored, and shared with third parties. For example, this law addresses whether your health plan can use your medical records for marketing purposes. URAC offers several accreditation programs to ensure that health care organizations have compliance programs in place that meet the intent of these requirements. These types of protections are becoming more important for patients since more information is being stored in electronic form.
Workers’ Compensation.
URAC offers several accreditation programs that ensure injured employees are protected while they are getting better. Standards that have been developed to assist injured employees cover areas such as case management, utilization management and network services.
Consumer Tips:
For more detailed summaries of URAC standards, click here
If you would like a free copy of our standards, please e-mail URAC’s Publications Department at Publications@urac.org. In the written communication, please include the following:
Identify the specific accreditation standards that you are requesting;
Please include a statement that you are using these standards for your personal use (Businesses must purchase our standards at (URAC’s Online Publication Store); and
Please provide contact information, including name, address, telephone number and e-mail address.
If you are an active member in a consumer group such as AARP, you are entitled to discounted books and educational conferences sponsored by URAC.