General Questions About URAC Accreditation
What is accreditation?
Accreditation is a process by which an impartial organization (URAC) will review a company's operations to ensure that the company is conducting business in a manner consistent with national standards.
What does "URAC" stand for?
Originally, URAC was incorporated under the name "Utilization Review Accreditation Commission." However, that name was shortened to just the acronym "URAC" in 1996 when URAC began accrediting other types of organizations such as health plans and preferred provider organizations.
Who does URAC accredit?
URAC accredits many types of health care organizations. It depends on the functions they carry out. We have a number of different accreditation programs, some that review the entire organization, such as the health plan standards, and some that focus on quality within a single functional area in an organization, e.g. case management or credentialing. Any organization that meets the standards, including hospitals, HMOs, PPOs, TPAs and provider groups can seek accreditation. Accreditation adds value to these programs by providing an external seal of approval, and by promoting quality improvement within the organization as part of the accreditation process.
How many organizations are accredited, and in what states?
URAC is the largest accrediting body for health care. We accredit programs that do business in every state. All of URAC's accredited companies are listed on this Web site. Check out the accredited companies link. You can search by state or by company name.
Is URAC accreditation accepted Nationwide?
Yes. Some states also "recognize" URAC accreditation, meaning that the accreditation can be used to meet state regulatory requirements instead of separate reporting to the state. A few states require URAC accreditation in order for companies to do certain types of business. For information on state deeming, click here.
How much does URAC accreditation cost?
That depends on the type of accreditation you are seeking. URAC's charges include the accreditation itself and charges for an onsite visit to your company by one or more of our accreditation reviewers. URAC has very reasonable prices compared to other accreditation organizations. We strive to make the process as cost effective as possible by promoting quality improvement throughout the process. For a detailed look at how much it would cost your company, call our Account Management Department at (202) 216-9010 or e-mail BusinessDevelopment@urac.org.
How Are URAC Standards Developed and Updated?
Who develops URAC's standards?
URAC standards are developed by a committee of experts representing diverse interests in the health care community: providers, health care organizations, insurers, and the public interest. When new standards are developed, experts from that particular area of health care delivery participate on the committee. URAC always circulates draft standards for public comment so that anyone can have input in the standards development process.
How often does URAC update the standards?
Generally, URAC updates its standards every three years. Occasionally changes in the health care environment necessitate making a change in the interim. URAC's Standards Committee recommends changes, which then go to URAC's Board of Directors for approval.
When are the new versions of the standards coming out?
URAC has multiple accreditation programs, each of which is on a separate cycle for revisions. Contact URAC with your specific questions or suggestions about proposed revisions to the standards.
How soon does an organization have to comply with revised standards?
An organization that has already started the application process when URAC releases revised standards generally will be able to choose which standards to use in the accreditation process - new or old. When the company seeks reaccredidation, however, it will have to comply with the new standards. If the standards change after you have purchased an application, you should contact URAC's Business Development Department at (202) 216-9010 or BusinessDevelopment@urac.org to discuss which standards you should use.
Getting Accreditation Information and the Standards
Are the standards on URAC's Web site?
Summaries of the standards are on the Web site, but you will need to order a copy of the standards from URAC. Free copies of the standards are available to state regulatory agencies by emailing URAC.GR@urac.org. All others, please contact BusinessDevelopment@urac.org
The Accreditation Process
How do I get started with accreditation?
We suggest that you order the standards for the accreditation program you are considering. Then your organization should conduct a self-assessment process to compare your current operations with those required by URAC's standards. You may need to make some changes in your operating policies and procedures to ensure compliance with the standards. We strongly recommend that one or more staff people from your organization attend a URAC educational program so that you understand how to interpret the standards and how to organize a successful application.
How long does the accreditation process take?
It usually takes 4-6 months to complete the process of accreditation once URAC receives your application. The amount of time it takes your organization to prepare the application may vary, depending on whether you have the appropriate policies and procedures in place and on the type of accreditation you are seeking.
What if we have questions while we are preparing an application?
URAC accreditation reviewers are available to answer questions you may have about the interpretation of standards. If you have questions regarding pricing you should contact URAC's Business Development Department. If you require extensive assistance in preparing your application, URAC maintains a list of consultants who have undergone training on the URAC application process. We can provide you a list of consultants if you call the Business Development Department. After you have submitted an application to URAC, URAC assigns an accreditation reviewer to work with you. You can call that person if you have questions or if you want to check on the status of your application.
Who makes accreditation decisions?
URAC assigns an accreditation reviewer to every application. That reviewer conducts the desktop and onsite reviews, summarizes the findings in an Executive Summary and presents this to the URAC Accreditation Committee (AC), which may grant accreditation to those applicants whose issues, if any, are resolved. The AC may also recommend an application for review to the Executive Committee which will decide to grant or deny accreditation. Information presented to the AC and EC about each applicant is blinded so that the committee members are not aware of the identity of the applicant.
What happens if I don't pass the accreditation process?
URAC offers an educational accreditation process. If it appears that an applicant is initially having difficulty meeting URAC's standards, URAC will work with you to help you revise your policies and procedures to improve your operations. This occurs before the application is presented to the AC. Once an application is presented to the AC, the AC can recommend several alternatives. We may place the applicant organization in conditional accreditation or corrective action with the option to review your organization again in a specified period. Alternatively, the lead reviewer may advise an organization that it is unlikely to pass accreditation. In that case, we will allow you to withdraw your application. Likewise, applicants have the option to appeal adverse accreditation decisions.
Health Plan and Health Network Standards
What is the difference between Health Plan and Health Network standards?
The Health Plan Accreditation program is for organizations that want a comprehensive review of their operations. There are five sections in the Health Plan standards: Network Management; Quality Improvement; Credentialing; Member Protection and Utilization Management (UM). The applicant must pass all of these sections. The standards are appropriate for HMOs and other integrated health plans. Health Network Accreditation does not include UM, and is generally more applicable to PPOs. It also has a phase-in option before the PPO has to complete credentialing of all providers.
Can specialty networks such as dental, vision or chiropractic medicine apply for accreditation?
Yes. URAC is the nation's largest accreditor of specialty organizations.
Utilization Management Standards
Does the program clinical director have to be a physician?
Not always. A program that is conducting UM for general medical processes must have a physician director. A specialty UM company, for example, a chiropractic UMO, can have a clinical director with the specialty credentials appropriate to the single service the UM conducts. In this case, a licensed chiropractor would be an appropriate choice for clinical director.
Do all clinical peer reviewers performing expedited and standard appeals need to be board certified?
Yes. For those that are physicians, they must be currently board certified by a board recognized by the ABMS or ABOS. "Board eligible" does not meet the standards.
Modular, Core, and Scoring
What is the Modular Accreditation System?
URAC's Modular Accreditation Systems allows for a diverse range of health care organizations to apply for URAC accreditation with the flexibility to achieve accreditation for a wide spectrum of managed care services. This approach adapts to the continuing evolution of the health care system. Each module is a set of standards established for a particular health care function.
Is my company eligible for Core stand-alone Accreditation?
Accreditation under the Core Standards is offered on a stand-alone basis for organizations that otherwise do not qualify for a URAC accreditation module. Eligibility will be based on the services offered by your organization. Contact URAC's Business Development Department for more information.