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Overview
Through URAC’s Health Utilization Management (HUM) Certifications, we help you meet the needs of your URAC-accredited partners. Whether you are performing delegated or other review services, our certification validates your program approach as well as the inherent value you bring your partner organization.
URAC offers four HUM Certifications, which means you can choose the ones most applicable to your business operations. You can also stagger your approach, obtaining one certification and then adding others once your company expands. URAC’s four HUM Certifications are:
- Pre-Review Screening Certification – also known as “initial screening” where staff receive the right information and support to provide excellent customer service
- Initial Clinical Review Certification – qualified professionals render certifications or move the review to the next level in a timely, responsive manner
- Clinical Decision Support Certification – promotes an effective and efficient utilization management process, optimizing workflow and outcomes
- Clinical Review Criteria Certification – used in the evaluation of medical necessity, criteria are regularly and rigorously reviewed by clinicians with appropriate credentials and experience
Review our Standards-at-a-Glance here for more details. Once you request a quote our team can help you decide which certifications are right for you. Applicant organizations may apply for up to three HUM certifications.
Benefits of Certification
Organizations that provide delegated or other support services for URAC-accredited Health Utilization Management organizations
First, URAC’s HUM Certification demonstrates your proven commitment to high performance by embedding quality management principles into your daily operations. The certification process verifies you have reviewed and confirmed your operational soundness, developed policies and procedures, set priorities and identified organizational improvements.
Second, URAC Certification means your HUM-accredited partners do not have to conduct delegation oversight; they will use your certification instead. This makes your organization an easy choice when they are selecting a service provider or delegated entity.
What to Expect
URAC conducts an independent assessment of your HUM approach. While our experts define the standards of excellence in utilization management, they do not prescribe how your practice should meet those standards, which provide a flexible framework for continuous improvement
In addition to the standards to be met for each certification, all HUM Certifications include the following Foundational Focus Areas:
- Risk Management
- Operations and Infrastructure
- Performance Monitoring and Improvement
- Consumer Protection and Empowerment
The certification process takes less than six months.
Who May Apply
- Pre-Review Screening Certification – Organizations delegated pre-review screening functions or organizations providing support for this function.
- Initial Clinical Review Certification – Organizations delegated initial clinical review functions or organizations providing support for this function.
- Clinical Decision Support Certification – Organizations providing clinical decision support to other entities for their use in making utilization management review determinations.
- Clinical Review Criteria Certification – Organizations providing clinical review criteria to other entities for their use in making utilization management review determinations.