URAC

URAC Accreditation

URAC is nationally recognized as the leading entity for accrediting specialty health plans. By applying for and receiving URAC accreditation, American Specialty Health Insurance Company (ASH Insurance Company), American Specialty Health Networks, Inc. (ASH Networks), American Specialty Health Plans of California, Inc. (ASH Plans), American Specialty Health IPA of New York, Inc. (ASH IPA), American Specialty Health ODS of New Jersey, Inc. (ASH ODS), American Specialty Health Networks of South Dakota, Inc. (ASH Networks SD), and Healthyroads, Inc, have demonstrated the commitment to be measured by nationally accepted health care benchmarks. This accreditation assures health plans, employer groups, members, and providers that ASH maintains the infrastructure and processes necessary to promote high-quality health care.

The URAC health program accreditations received by ASH include a comprehensive review of organizational structure, administrative services, network management, quality management, utilization management, provider services, provider credentialing, member participation and protection, and claims processing. Although URAC also offers a certification process available to organizations that opt for a less comprehensive evaluation, ASH has opted to pursue full accreditation rather than the certification process.

Program Scope, Date First Accredited, Dates of Current Cycle

Health Plan (including chiropractic, acupuncture, massage therapy, naturopathy, and dietetic counseling programs) - These standards include key quality benchmarks for network management, provider credentialing, utilization management, quality management and improvement and consumer protection. The standards are appropriate for HMOs and other integrated health plans. First accredited: 11/98. Current cycle: 11/10-11/13.
Health Network with Credentialing (including chiropractic, acupuncture, massage therapy, naturopathy, and dietetic counseling programs) - Health Network Accreditation is similar to Health Plan, but does not include UM, and is generally more applicable to PPOs. First accredited: 11/98. Current cycle: 11/10-11/13.
Health Utilization Management (including chiropractic, acupuncture, massage therapy, naturopathy, and dietetic counseling programs) – These standards ensure that organizations conducting utilization review follow a process that is clinically sound and respect patients’ and providers’ rights while giving payors reasonable guidelines to follow. First accredited: 11/98. Current cycle: 11/10-11/13.
Claims Processing Organization (including chiropractic, acupuncture, massage therapy, naturopathy, and dietetic counseling programs) - This program is designed to validate that standards are met in areas such as accuracy, timeliness, notification to claimants, and quality monitoring. First accredited: 2/03. Current cycle: 11/10-11/13.
HIPAA Privacy - ASH affiliates holds URAC’s HIPAA Privacy accreditation and HIPAA Security accreditation. These programs outline a framework of best practices that describe the operational policies and procedures necessary for an effective HIPAA compliance program. ASH received accreditation as both a covered entity and a business associate. First accredited: 7/03. Current cycle: 7/09-7/12.
HIPAA Security - ASH affiliates holds URAC’s HIPAA Privacy accreditation and HIPAA Security accreditation. These programs outline a framework of best practices that describe the operational policies and procedures necessary for an effective HIPAA compliance program. ASH received accreditation as both a covered entity and a business associate. First accredited: 12/03. Current cycle: 12/09-12/12.
Health Website: www.HealthyRoads.com . These standards promote creditability, trust, and quality of online health information and privacy practices of Web sites. First accredited: 2002. Current cycle: 2/10-2/12.
Comprehensive Wellness Program: These standards require a comprehensive wellness organization to develop programs that address the risk types and interventions associated with the wellness program, and define the excepted outcomes. The standards and measures encourage industry-wide quality improvement and promote best practices, while protecting and empowering consumers. First accredited: 1/09. Current cycle: 1/09-01/12.
Disease Management (provisional for a start up organization): The URAC Disease Management standards promote quality and provide tools to better assess and respond to the needs of members. Standards promote evidence-based practice, collaborative relationships with providers, consumer education, and shared decision making with consumers. First accredited 1/2012. Note: The provisional accreditation affords new programs the opportunity to demonstrate that the design, staffing and evidence-based model of the disease management program meets all the standards. As the Healthyroads Condition Coaching program demonstrates it is executing the accredited operational processes, creating member files, and outcomes, Healthyroads will complete the process and seek to replace "provisional accreditation" with "full accreditation." Healthyroads expects to complete its onsite survey by mid-2013 to earn full accreditation for the URAC Disease Management program

ASH staff receives training on NCQA and URAC requirements upon hire and annually thereafter. As new requirements are developed and/or revised, they are presented to ASH’s Corporate Compliance Committee (CCC). The CCC reviews the standards and determines the current level of compliance. If changes are required to support the new requirement, the CCC delegates action items to the applicable key process teams to implement the change and ensure compliance with these standards. Action items are maintained on a master action log and monitored by CCC until completed.

Accredited health plan clients perform regular delegation audits and no audit has resulted in de-delegation for failure to perform or comply with URAC or NCQA. To achieve and maintain successful delegation audit results, ASH’s operations consistently support all applicable accreditation organization standards.

ASH is committed to maintaining URAC accreditation and NCQA Organization Certification in Utilization Management and Credentialing. More information is available at the URAC Web site (www.urac.org) and at the NCQA Web site (www.ncqa.org).