With increased expectations for providers to demonstrate quality while controlling costs, dental plans can differentiate themselves through URAC Dental Plan Accreditation.
This accreditation program requires compliance with industry best practices in all areas of dental plan management, including member and provider services, utilization management, grievances and appeals, provider contracting, credentialing, human resources, quality improvement, and regulatory and HIPAA/HITECH compliance.
The URAC-accredited dental plan:
- Has implemented a participating provider relations program that includes orientation, updates, fee schedule changes, dispute resolution mechanisms, and more
- Meets requirements for a credentialing program to verify professional qualifications of providers
- Ensures that its marketing and sales activities do not misrepresent the benefit plans, coverage, provider availability and accessibility, and more
- Gathers information about consumer satisfaction with its services to identify trends and opportunities for improvement
- Makes complaint and appeals processes available to consumers
- Maintains a quality management program that measures, monitors, and evaluates services and work processes, and implements quality improvement based on outcomes
- Establishes three quality improvement projects that address opportunities for error reduction or performance improvement related to the services covered by the accreditation
- Meets requirements for health and drug utilization management
- And more.
Dental plans that achieve the URAC Accreditation Seal differentiate themselves by demonstrating a commitment to continuous quality improvement and by verifying their adherence to a set of rigorous quality standards.
Who may apply
Dental plans operating in the United States and its territories.