Health plans that offer services on The Health Insurance Marketplace® must be accredited by an approved accreditor. URAC’s Marketplace Health Plan Accreditation is specifically recognized by the Department of Health and Human Services (HHS) as a qualifying accreditation.
This program mirrors the URAC Health Plan Accreditation and adds standards specific to the Marketplace. Only URAC brings you a wealth of industry knowledge to drive efficiencies and outcomes to help you succeed in this evolving value-based arena.
Short- And Long-Term Benefits
Although accreditation is required, URAC’s singular process for you to secure this respected seal of approval will strengthen the level of quality throughout the health plan organization. Your organization can expect to benefit in numerous ways, including:
- Assure government regulators and providers your organization meets rigorous standards and measures of operational integrity, such as mental health parity
- Elevate contracting power and increase revenue by supporting performance-based measures and outcomes
- Improve member satisfaction and loyalty through services to identify trends and opportunities for improvement as well as ensure clear communication about benefit plans, coverage, provider availability, protections and more
- Become a lean, smarter and more effective organization by streamlining quality management processes and improving regulatory compliance based on proven outcomes
- Enhance provider satisfaction through programming that documents and optimizes orientation, fee schedule changes, dispute resolution mechanisms, clinical practice guidelines, clinical review criteria and other essential activities
- Deliver risk management peace-of-mind with standards that prevent, protect and manage liabilities, including patient safety, patient health and drug utilization management
Quality Improvement Activities
The Health Plan Accreditation program gives you access to a team of health care experts who work collaboratively with your staff to ensure compliance with industry best practices in all areas of management, including:
- Regulatory and Compliance
- Information Management
- Consumer Protection and Empowerment
- Network Management
- Utilization Management
- Mental Health Parity
- Population Health Management
- Marketplace Requirements
Download our Marketplace Health Plan Standards-at-a-Glance.
We meet you where you are when it comes to standardized performance measures, particularly those related to clinical performance and member satisfaction. Our flexible process is compatible with measures you have in place or are required to report, including CAHPS® and HEDIS®.
What to Expect
In ten months or less, URAC will conduct an independent evaluation of your marketplace health plan. URAC's standards provide a flexible framework for continuous improvement without prescribing how to meet those standards. URAC’s approach stimulates innovation across the continuum of care through email, conference calls and web conferencing.
Who May Apply
Any health insurance plan eligible to operate on the Marketplace can apply. This includes health systems, health maintenance organizations, preferred provider organizations and Medicaid. As a non-profit working to strengthen quality standards across the health care continuum, URAC now offers special pricing to accommodate small health plans.