URAC's health utilization management accreditation is recognized by many states and the federal government, which underscores its importance in ensuring quality and efficiency in health care services.
This recognition can enhance the credibility of organizations that achieve this accreditation, helping them meet regulatory requirements and improve their operational standards.
With our origins in utilization review and utilization management, URAC set the bar for Health Utilization Management (HUM) in 1990 with the development of the country's first utilization management accreditation standards. Now, URAC-accredited organizations serve patients in every state across the country.
Modular Approach
URAC offers five modules to address the HUM functions performed by each organization, giving you the option to choose the one(s) most applicable to your business operations.
The five HUM modules are:
- Pre-Review Screening– also known as “initial screening” where staff receive the right information and support to provide excellent customer service
- Initial Clinical Review– qualified professionals render certifications or move the review to the next level in a timely, responsive manner
- Clinical Decision – promotes an effective and efficient utilization management process, optimizing workflow and outcomes
- Clinical Review Criteria– used in the evaluation of medical necessity, criteria are regularly and rigorously reviewed by clinicians with appropriate credentials and experience
- Comprehensive – an organization that performs all of the functions in the other modules, as well as conducts appeals.
Health Utilization Management Accreditation
Applies to stand-alone UM Organizations and to UM functions inside health benefit programs
Workers’ Compensation Utilization Management Accreditation
Provides for determination of medical necessity for workers covered under a Workers' Compensation program
What To Expect
Within six months or less, we will provide an impartial evaluation of your utilization management program.
URAC’s thorough approach to accreditation stimulates utilization management program best practices, through email, conference calls and educational webinars.
