NCQA accredits organizations ranging from health plans including HMOs and PPOs to physician networks and medical groups. URAC accredits health plan programs including dental plans, healthcare management programs, pharmacy quality management programs, and provider integration and coordination programs.
What are URAC requirements?
- Promote industry best practices.
- Encourage quality improvement.
- Protect and empower consumers.
What is the benefit of URAC accreditation?
A URAC-accredited organization meets CMS Medicare Advantage regulatory standards in the following areas: Quality improvement . Antidiscrimination. Confidentiality and accuracy of enrollee records.
How often is URAC accreditation?
Most accreditations are awarded for a period of three years . Organizations are provided accreditation certificates and are listed in the online URAC Directory of Recognized Companies.
How many URAC accreditation does the organization have?
URAC Health Plan Accreditation
And there are 13 states where URAC fulfills state requirements for health plan accreditation: Connecticut, Florida, Iowa, Michigan, Minnesota, Montana, North Dakota, New Jersey, New Mexico, Nevada, Texas, Utah and Vermont.
What is the mission of URAC?
Advancing the quality of health care through leadership, accreditation, measurement and innovation .
Is NCQA an accrediting body?
The National Committee for Quality Assurance (NCQA) accredits and certifies an array of healthcare organizations, including providers, practices and health plans . The non-profit organization began in the early 1990s by measuring and then accrediting health plans.
Why is NCQA accreditation important?
NCQA helps health plans work together to improve quality and lower costs . We accredit health plans that deliver high-quality care and enforce important safeguards to protect the people they cover. More than 173 million Americans are in an NCQA-Accredited health plan.
Is URAC recognized in all states?
URAC is widely recognized by nearly every state and the federal government for our health utilization management accreditation program.
What is a URAC audit?
URAC is the Gold Standard for Health Care Accreditation
URAC’s approach to the accreditation process allows organizations to improve their health care activities through collaboration and iteration. This approach allows you to determine the best way forward for your organization’s improvements.
Does accreditation improve the performance of an organization?
General accreditation programs appear to improve the structure and process of care , with a good body of evidence showing that accreditation programs improve clinical outcomes. The best study that evaluated this area was the Quality Assurance Program (QAP) trial.
What are the five steps of URAC’s approach to the accreditation process?
- 1. “ Get to Know You” – Application Submission. ...
- 2. “ Elevate Your Policies and Processes” – Desktop Review. ...
- 3. “ Walk the Talk” – Validation Review. ...
- 4. “ Strive to Earn a Gold Star” – Committee Review. ...
- 5. “ Stay the Course” – Ongoing Monitoring.
What does NCQA stand for?
The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care.
What is Specialty Pharmacy accreditation?
NABP’s Specialty Pharmacy Accreditation is a three-year accreditation best suited for pharmacies providing an advanced level of pharmacy services and disease management for patients taking medications that require special handling, storage, and distribution requirements .
What does Achc stand for?
The Accreditation Commission for Health Care (ACHC) is a United States non-profit health care accrediting organization. It represents an alternative to the Joint Commission and CHAP, The Community Health Accreditation Program.
What are the NCQA accreditation levels?
| Current Status Projected Stars | Excellent 4.5-5.0 | Commendable 3.5-4.0 | Accredited 2.5-3.0 | Provisional 1.0-2.0 |
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What is NCQA standards for credentialing?
NCQA Credentialing Accreditation is designed to ensure that organizations can maintain a high-quality network for members and contracted clients . Requirements cover these key areas: An internal QI process. Ensuring appropriate agreements and collaboration with clients.
What is a HEDIS audit?
The NCQA HEDIS ® Compliance AuditTM indicates whether an organization has capabilities for processing medical, member and provider information as a foundation for accurate and automated performance measurement, including HEDIS reporting . The audit addresses an organization’s: Information practices and control procedures.
