Company Info - Accreditations

BCBSKS Means Quality

Case management

URAC is the only accreditation organization offering standards that specifically address the rapidly evolving field of case management. According to URAC, completing the case management standards enable organizations to successfully train case managers, identify individuals for case management, manage and conduct case management activities in an efficient and professional manner, promote the autonomy of consumer and family decision making, maintain confidentiality and delegate responsibility.

Utilization management

URAC’s health utilization management (UM) accreditation standards ensure that all types of organizations conducting utilization review follow a process that is clinically sound and respect patients’ and providers’ rights while giving payers reasonable guidelines to follow. URAC’s health utilization management standards address:

• Medical necessity criteria that is evidence based and promotes consumer safety
• Specialty matched clinical peers for medical necessity review
• Requirements for consistency in maintaining the highest confidentiality in UM processes as we approach a new age with electronic health records (EHR) and health information exchanges

Disease management

URAC works one-on-one with each organization to create a tailored program from the ground up – a program that is fully documented, employs a valid evaluation process, reports on its performance, seeks provider feedback and respects consumers. Coupled with the core standards, obtaining URAC’s disease management accreditation ensures that organizations:

• Implement a process to assess the health condition of each participant, taking into account cases where more than one chronic health condition may be present
• Conduct assessments according to a standard process
• Implement interventions designed to respond to the specific health needs of the patient
• Employ evidence-based decision-support tools that are reviewed and updated annually

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