Original source is the URAC website

I am sure that you like everyone else has certain questions regarding URAC accreditation and might not have known where to find the answers. We are providing some of the questions for you and you can review the frequently asked questions section of the URAC website for the full array. Following are a few of the questions to wet your appetite and your thirst for knowledge.

1. Do all clinical peer reviewers, who perform physician advisor standard reviews as well as expedited reviews, need to be board certified? Absolutely, they must be certified by either ABMS or ABOS. I know the next question you are going to ask is “Does board eligible meet the definition of board certified?” No, board eligible doesn’t cut the mustard.
2. Did you know that URAC has another name that is sometimes used as “doing business as (DBA)”? The other name that is sometimes used on contracts and other legal documents is the American Accreditation HealthCare Commission, Inc.
3. What is accreditation anyhow? Accreditation is the process of an independent organization reviewing an organization’s policies, procedures and operations to ensure the organization is compliant with the national standards.
4. So, what types of organizations can become accredited? At this time, accreditation can be sought by hospitals, HMOs, PPOs, TPAs, and provider groups.
5. How do I know if a company is accredited? The URAC website lists all organizations that are either accredited or seeking accreditation. Go to the website and you will see BHM Healthcare Solutions listed as accredited.
6. BHM Healthcare Solutions

1. Is URAC national accreditation or within the states? It is national, but also may be used by some states to meet certain regulatory requirements.
2. Who is in responsible for the standards and how they are updated? They are developed by a committee of experts in the healthcare community including: providers, health care organizations, insurers, and the public interest. Drafts of any new standards are circulated for public comment to give everyone the opportunity to review and comment.
3. How long does the accreditation process take? Generally 4-6 months
4. In whose hands is the decision whether or not to accredit my organization? Each organization is assigned to an accreditation reviewer. The reviewer completes both the desk audit and the onsite review, summarizes the findings and presents to the URAC Accreditation Committee (AC). The AC can make the decision or may recommend it go before the Executive Committee.

These are just a few of the questions located on the URAC website. One of URAC’s concerns as it relates to Independent Review Organizations is medical necessity. We would like to offer a free presentation on medical necessity criteria. Please click on the following:

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