Studies show that convenience, insurance coverage and affordability matter most to people when selecting health care providers and facilities. As patients become more sophisticated consumers of health care—with the help of digital resources—provider experience, reputation and satisfaction ratings/reviews are equally important to them as they navigate the delivery system.
These factors also influence payers such as health plans and hospitals trying to attract and retain health care consumers.
By earning Health Network Accreditation from URAC, you eliminate the guesswork. URAC’s well-respected stamp of approval tells patients and payers that your network meets the highest industry standards in delivering quality care and services.
The URAC Difference
URAC’s Health Network Accreditation standards include key quality benchmarks for network management, provider credentialing and recredentialing, quality management and consumer protections. We also require health networks to establish self-monitoring practices, emphasizing quality assurance and improvement.
The Health Network Accreditation infrastructure requires that you meet 40 specific core standards of best in class network operations across the following areas:
- Organizational Structure
- Policies and Procedures
- Regulatory Compliance
- Delegated Functions
- Marketing and Sales
- Information Management
- Quality Management
- Staffing and Oversight
- Consumer Rights, Safety and Satisfaction
Our accreditation also includes rigorous requirements for network management, credentialing and recredentialing.
Benefits of Accreditation
URAC Accreditation assures patients and purchasers that your network providers and facilities meet professional qualifications and have been properly vetted through a rigorous credentialing process. Furthermore, Health Network Accreditation indicates that you continuously monitor and evaluate provider performance, taking quality of care, program compliance and patient feedback into consideration to determine ongoing network participation.
Additional benefits of Health Network Accreditation include:
- Establishment of appropriate patient protections, including formal policies and procedures for confidentiality, informed consent, complaints, dispute resolution, consumer safety investigations and other issues
- Validation of compliance and adherence to applicable state and federal regulations
- Implementation of risk management oversight and review protocols that prevent, protect and manage client liabilities as well as data security
- Development of a roadmap for ongoing process and quality improvements that enhance care delivery, ensure sound provider practices and optimize operational efficiencies
What to Expect
Within six months or less, we will collaborate with your team to create a flexible framework for continuous improvement in health network management. While our experts define the standards of excellence, they do not prescribe how your organization must meet those standards.
URAC’s thorough approach stimulates innovation across the continuum of care through email, conference calls and educational webinars.
We award accreditation for a full three years. Review our Health Network Standards-at-a-Glance for more information.
Who May Apply
Preferred provider organizations, payer- and provider-based models, behavioral health networks, specialty medical networks (radiologists, audiologists, physical therapists, optometrists, long-term care providers, etc.), physician-hospital organizations, chiropractic networks, workers' compensation networks and medical transportation providers may apply.