Workers’ compensation programs are challenged with getting the injured worker back to work as soon as possible while containing spiraling medical costs, which means addressing the critical aspects of managing care including pain management, opioid use and addiction, and over-utilization of injections. Plus, if the utilization management process is inadequate, patient safety is at risk.
With today’s focus on improved patient outcomes and cost reduction, the utilization management process has become even more critical. The goal is to ensure that the injured worker gets the best medical care, which calls for the prevention of unnecessary treatment, the prevention of over-use or under-use of prescription drugs, and lowering the overall cost of medical care.
The URAC accreditation seal demonstrates your organization’s commitment to quality, nationally recognized guidelines and evidence-based medicine. Your clients can be assured that your processes meet widely recognized national standards and respect patients’ and providers’ rights.
The URAC-accredited Workers’ Compensation Utilization Management program:
- Employs drug utilization management mechanisms to address therapeutic appropriateness, over and underutilization, dosage, duration of treatment, duplication, drug allergies, and more
- Provides an independent, unbiased determination of medical necessity beginning with an initial clinical review, then moving to a peer clinical review if needed
- Is prepared to address any risk to patient safety, such as contraindicated treatments, adverse drug interactions, or inappropriate treatment, during the review process
- Adheres to time frames outlined in the standards for urgent and non-urgent review determinations
- Understands and adheres to applicable state and federal regulations for Workers’ Compensation programs
- And more.
URAC is named as a designated accreditor of workers’ compensation utilization review in California, Delaware, District of Columbia, Illinois, Indiana, Maine, New York, and Ohio.
Download our Workers' Compensation Utilization Management Standards-at-a-Glance.
Who May Apply
Managed care companies, health plans, health networks, case management companies, medical review companies and health care claims management companies may apply.