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Workers’ Compensation coverage protects both employees and employers in the event of a workplace injury or related illness. While the long-term impact of COVID-19 on workers’ compensation claims are unknown, what remains constant is the need to ensure patient safety and quality care while containing spiraling medical costs. During these unprecedented times, the utilization management (UM) process has become even more critical.
URAC’s Workers’ Compensation Utilization Management Accreditation demonstrates your organization’s commitment to quality and adherence to nationally recognized guidelines. Your clients can be assured that your workers’ compensation program respects both patients’ and providers’ rights.
The URAC Difference
Our three-year accreditation includes standards that reflect industry best practices for utilization management that address initial screenings, clinical review, decision timeframes, utilization policy, appeals and more.
Once your organization begins the process, you can be accredited in six months or less.
Workers' Compensation Utilization Management Accreditation Benefits
The basis of a successful UM program is to provide an independent, unbiased determination of patient medical necessity beginning with an initial clinical review, then moving to a peer clinical review if needed. The process ensures patients receive timely, effective treatment (and necessary medications) within accepted medical guidelines. Workers’ Compensation UM programs have the added complexity of the requirement to determine return-to-work readiness.
URAC’s Workers’ Compensation Utilization Management Accreditation provides a valued credential of quality that recognizes your expertise in determining care appropriateness with a focus on patient safety and recovery.
The basis of a successful UM program is to provide an independent, unbiased determination of patient medical necessity beginning with an initial clinical review, then moving to a peer clinical review if needed. The process ensures patients receive timely, effective treatment (and necessary medications) within accepted medical guidelines. Workers’ Compensation UM programs have the added complexity of the requirement to determine return-to-work readiness.
URAC’s Workers’ Compensation Utilization Management Accreditation provides a valued credential of quality that recognizes your expertise in determining care appropriateness with a focus on patient safety and recovery.
Benefits of URAC's Workers' Compensation Utilization Management Accreditation include::
- Documenting a consistent, clinically sound review process that guides patients through all aspects of their medical care and mitigates patient safety risks such as contraindicated treatments, adverse drug interactions or inappropriate treatment
- Implementing drug utilization management protocols to address therapeutic appropriateness, over and underutilization, dosage, duration and duplication
- Implementing risk management oversight and review protocols
- Developing a roadmap for ongoing UM process and quality improvements that enhance care delivery, lower overall health care costs and optimize operational efficiencies
Accreditation Process: What to Expect
At URAC, our accreditation process is more than collecting metrics and checking boxes. URAC offers your organization a collaborative, comprehensive learning experience designed to enhance knowledge and promote quality practices.
The program helps highlight the work your organization already does or can help guide your practice as you build the infrastructure to support worker’s compensation utilization review.
Who May Apply
To be eligible for URAC’s Worker’s Compensation Utilization Management Accreditation, an organization must complete determination of medical necessity for injured workers, peer clinical reviews, and if applicable, appeals. Organizations must be operating in the U.S. Download our Worker’s Compensation Utilization Management Standards-at-a-Glance for more information.