Medicare Advantage Accreditation

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To ensure compliance with certain Medicare requirements, MA organizations may use accreditation. URAC is a CMS-approved accreditation organization for MA deeming of HMOs and PPOs.

The Centers for Medicare and Medicaid Service’s (CMS’s) deeming program allows Medicare Advantage (MA) organizations to satisfy certain federal requirements by earning accreditation from an approved accrediting organization. This program allows MA organizations to earn “deemed” status for CMS requirements in the permitted domains, thus avoiding a full CMS audit.

URAC was approved as a CMS-approved accreditation organization for MA deeming of HMOs/PPOs in 2012 for a six-year term. CMS has renewed URAC’s status as an approved accreditor for MA plans, granting URAC “deeming authority” for a new six-year term, through June 2, 2025.

URAC clients benefit from our unique accreditation process, which facilitates learning and helps the organization create a framework for continuous improvement. In addition, URAC’s MA program features a simplified accreditation process, focused standards, reduced compliance burden, and affordable pricing. Understanding the value of integrated care, URAC weaves key behavioral health components into our Medicare Advantage standards.

The URAC-accredited organization meets CMS Medicare Advantage regulatory standards in the following areas:

  • Quality improvement
  • Anti-discrimination
  • Confidentiality and Accuracy of Enrollee Records
  • Information on Advance Directives
  • Provider Participation Rules

Download our Medicare Advantage Standards-at-a-Glance.

Who may apply?

Health plans, including Health Maintenance Organizations and Preferred Provider Organizations.

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