Understanding Quality Measurement | Agency for Healthcare Insurance

Quality health care doesn't just happen. By meeting strict quality standards to ensure clinically sound decision-making that respects the rights of both patients and medical providers, UHA Health Insurance receives accreditation in Health Utilization Management through URAC, an independent non-profit organization that promotes health care quality through accreditation and certification programs.

What is Health Utilization Management?

Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan, sometimes called “utilization review.”

What is URAC’s Health Utilization Management Accreditation?

URAC’s Health Utilization Management Accreditation ensures that all types of organizations conducting utilization review follow a process that is clinically sound and respects patients’ and providers’ rights while giving payers reasonable guidelines to follow. URAC’s standards address the use of evidence-based guidelines, outline specific reviewer requirements for each level of review, and require a policy preventing financial incentives to doctors and other providers based on consumers’ use of health services; thus, the standards meet the demands of a changing health care system. URAC’s accreditation ensures the adequacy of health utilization management programs through evaluation against broadly recognized standards and measures.

Source: https://www.urac.org/accreditation-cert/health-utilization-management-accreditation/

For more information on URAC, visit www.urac.org.