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URAC’s New Uniform External Review Accreditation Demonstrates Health Plan Compliance with National Association of Insurance Commissioners’ Model Act

Tuesday, November 10th, 2009

Program Guides Health Plans, Consumers, and Providers Through New State Requirements for Mandatory External Review

Washington, D.C., November 10, 2009 – URAC, the nation’s leading health care accreditation and education organization, today announced its new Uniform External Review (UER) Accreditation Program. The program is designed to help utilization management organizations, third-party administrators, and other health benefit plans demonstrate compliance with the National Association of Insurance Commissioners’ (NAIC) Uniform Health Carrier External Review Model Act, which is being considered by state legislators.

“The standardized protocols for external review in the NAIC Model Act establish a safety net for consumers,” said Alan P. Spielman, president and CEO of URAC. “These provisions ensure that consumers have a way in which they can obtain independent review of a health insurer’s coverage denial of specific procedures or services.”

The National Association of Insurance Commissioners (NAIC) adopted the Uniform Health Carrier External Review Model Act in June 2008 to standardize the many variations that exist state-by-state in their protocols for external review. The external review process is designed to ensure that consumers have an avenue to seek an independent review of a health insurer’s refusal to pay for specific procedures or services.  Connecticut, North Carolina, and Idaho have already enacted legislation based on the Model Act. Illinois and Tennessee are also considering legislation, and other states may follow.

“By aligning its standards with the NAIC Model Act, URAC streamlines the process for managed care providers to comply with state insurance laws and regulations,” said Scott J. Kipper, Nevada Insurance Commissioner and Vice-Chair of the NAIC Consumer Liaison Committee.  “URAC accreditation helps reduce the oversight burden on state regulators by having a third-party conduct an independent review, while still offering the same high quality protections for consumers that NAIC had envisioned.”

“The health care landscape is constantly changing and it can be difficult to keep up with various state and federal regulations. The Uniform External Review Accreditation Program provides for an independent review process that is expeditious and transparent to all parties – consumers, treating providers, and health insurers,” saidChristine G. Leyden, RN, MSN, Senior Vice President and Chief Accreditation Officer for URAC. “URAC developed its Uniform External Review Standards and Accreditation Program to mirror the NAIC standards for processing, conducting, and making external review determinations for insurance coverage, which will help to reduce health care confusion for consumers.”

The new UER Standards and Accreditation Program became available on November 1, 2009 to health care organizations that are accredited or in-process with URAC for Health Plan or Health Utilization Management accreditation. For additional information, please visit www.urac.org or contact businessdevelopment@urac.org.


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.

Interested in accreditation?
Contact businessdevelopment@urac.org

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