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URAC Seeks Public Comment on Proposed Claims Processing Accreditation Standards

Thursday, June 28th, 2012

Public Input Sought at https://www.urac.org/publiccomment/ through August 10, 2012

Washington, D.C. – June 28 , 2012 – URAC, a leading health care accreditation, education, and measurement organization, today opened a call for public comment to share input and opinions on proposed standards revisions for its Claims Processing Accreditation program. Members of the health care industry are encouraged to provide their comments on the proposed URAC standards at https://www.urac.org/publiccomment/. The deadline for public comment is 6:00 pm EDT on Friday, August 10, 2012.

“URAC is committed to having the broadest possible input into its standards development process,” said Alan P. Spielman, President and CEO of URAC. “We strive to ensure that our accreditation is meaningful across the health care spectrum, including consumers, purchasers, providers, regulators, and the industry. Public input is a very important part of this process.”

URAC is revising its standards to reflect trends in the industry and to align with government regulations, including the Administrative Simplification Provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA). Under these regulations, organizations are required to implement mandated operating rules intended to achieve greater uniformity with the transmission of health information. These modifications are designed to promote more efficient electronic data exchanges, enable providers and payers to process financial and administrative transactions expeditiously, and facilitate cost containment. To promote industry excellence, standards were also revised with an emphasis on ‘Quality Performance Monitoring’ tailored to the claims industry

In addition to aligning with various federal regulations, the Claims Processing standards were restructured to reflect current industry practices. Third Party Administrators (TPAs) serve an essential contractor role in the industry for to process health care claims. The existing claims processing standards include claims review and appeal functions, which are typically out of scope for a TPA given that they are not a fiduciary for the health plan. The new URAC program will allow organizations to demonstrate excellence in the area of claims processing operations and recognize a separate process for claims review and appeals. This includes designating two separate claims processing accreditation programs:

  • Claims Processing Administration:
    • (TPAs)
  • Claims Processing Administration with Claims Review and Appeals:
    • Health plans, health plan vendors, TPAs; with claims review and appeals business operations.

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For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

For more information about URAC, contact us.

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