URAC, formerly known as the Utilization Review Accreditation Commission, is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations.

Mission

URAC's mission is to promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.

History

In the late 1980s concerns grew over the lack of uniform standards for utilization review (UR) services. UR is the process where organizations determine whether health care is medically necessary for a patient or an insured individual. As a result of this public concern, URAC was founded in 1990 with a mission to improve the quality and accountability of health care organizations using UR programs.

From conception, the founders of URAC recognized that an accreditation organization would not be accepted by regulators, health care providers and consumers if controlled by industry interests. To avoid this, several operating principles were incorporated into URAC's structure and bylaws. First, URAC was set up as an organization independent of any particular stakeholder group. Second, the governing board of directors was established with representatives from all affected constituencies: consumers, providers, employers, regulators and industry experts. Today, over 500 committee volunteers and paid staff help run the organization.

In the mid to late 1990s, URAC's mission expanded to cover a larger range of service functions found in various health care settings including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services.

Accreditation

URAC's accreditation process consists of a review of policies and procedures and an onsite visit to the applicant organization to determine that it is, in fact, operating according to its stated policies. If an applicant organizations passes their review, an accreditation is awarded with a valid period of two to three years after which the organization must go through the review process again to maintain its accredited status.

URAC accredits many types of health care organizations including medical management organizations (disease management

Disease management (health)

Disease management is defined as "a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant." For people who can access health care practitioners or peer support it is the process whereby persons with...

, case management, health call centers, Independent review organizations, etc.), health plans (HMOs, PPOs, etc.), hospitals and health websites.

Accreditation programs

Case Management	Claims Processing	Consumer Education & Support	Core	Comprehensive Wellness
Credentials Verification Organization	Disease Management	Drug Therapy Management	Health Call Center	Health Content Provider
Health Network	Health Plan	Health Provider Credentialing	Health Utilization Management	Health Web Site
HIPAA Privacy	HIPAA Security	Independent Review Organization	Mail Service Pharmacy	Medicare Advantage Deeming Program
Pharmacy Benefit Management	Provider Performance Measurement and Public Reporting	Specialty Pharmacy	Uniform External Review	Workers' Compensation Health Network
Workers' Compensation Utilization Management	Workers' Compensation Property and Casualty Pharmacy Benefit Management	Patient Centered Health Care Home [PCHCH] Practice Achievement	Patient Centered Health Care Home [PCHCH] Auditor Certification

Accreditation standards development

URAC standards are developed by a committee of experts representing diverse interests in the health care community: employers, health care providers, health care organizations, insurers, and the public interest. When new standards are developed, experts from that particular area of health care delivery participate on the committee. URAC always circulates draft standards for public comment so that anyone can have input in the standards development process.

Education

Educational programs include workshops, conferences, webinars and audio conferences for individuals and companies in the health care industry to learn about best practices in URAC accreditation in addition to the latest updates on issues at the forefront of health care directly from industry experts and URAC staff. Many of URAC's educational programs have been approved for Nursing CEU's, CCM CEU's and other continuing education credits.