Participation Criteria

URAC welcomes a conversation to discuss your organization and special pricing, which involve criteria such as number of covered lives.

Short- And Long-Term Benefits

Every part of a health plan’s organization that touches a member or provider performs better when driven by URAC standards. Earning the prestigious Health Plan Accreditation from URAC brings a plan-wide quality management framework along with numerous benefits:

  • Assure government regulators and providers that your organization meets rigorous standards and measures of operational integrity
  • 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

Performance Measures

We meet you where you are when it comes to standardized measures, particularly those related to clinical performance and member satisfaction. Our flexible process is compatible with any measures you have in place or are required to report, including CAHPS® and HEDIS®.

Quality Improvement Activities

The Health Plan Accreditation program gives you access to a team of specialty experts who work collaboratively with your staff to ensure compliance with industry benchmarks and best practices in all areas of management, including:

  • Wellness and Health Promotion
  • Care Coordination
  • Medication Safety and Care Compliance
  • Quality Rewards
  • Care Delivery through a Patient Centered Health Care Home Network
  • Mental Health Parity
  • HIPAA Breach Requirements
  • Measures, including patient centeredness, communication and care coordination, patient safety, community, population and public health, efficiency and cost reduction and effectiveness of clinical care
  • Patient Experience of Care (CAHPS® Survey)

Download our Health Plan Standards-at-a-Glance.

Related Accreditations

What to Expect

In six months or less, URAC will collaborate with your team to create 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

Health plans, including commercial plans such as health maintenance organizations, preferred provider organization, self-insured and Medicaid plans, are eligible to apply.