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New URAC Issue Brief Answers Questions About Delegated Credentialing, Transparency in Physician Tiering Programs
Date:6/17/2008

Brief will be released at AHIP Institute July 18-20

WASHINGTON, June 17 /PRNewswire-USNewswire/ -- A new issue brief from URAC provides answers for health plans and health networks wrestling with market demands for physician measurement and new trends in outsourcing of credentialing services.

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The brief will become available during the AHIP Institute, June 18-20 in San Francisco. URAC is an AHIP exhibitor and will also be offering educational workshops for several of its accreditation programs during the Institute, including workshops for Health Network and Health Plan accreditations.

Health plans and health networks must balance the purchaser's need for assurance about the quality and efficiency of practitioners with the burden to provide broad access to desirable providers. URAC's standards surrounding provider credentialing help clarify how organizations can strike this balance in an environment where more companies are outsourcing credentialing services.

"URAC's standards require that the plan or network still is the party that renders the decision to allow the provider to participate in the network, even if the credentialing process itself is outsourced," said Christine Leyden, URAC's chief accreditation officer. "The delegated credentialing requirements ensure that plans and networks are still applying the same quality standards to their vendors' credentialing process and keeping consumer protection top-of-mind."

Most health plans and health networks still do the majority of credentialing in-house, although a growing number of organizations delegate credentialing by contracting with a qualified vendor to assist in the process. Vendors may be located either in the United States or abroad. According to both quantitative and qualitative research conducted by URAC in 2007, credentialing is among the top administrative functions currently outsourced by U.S.-based health care management organizations.

URAC-accredited health plans and health networks are still responsible for oversight and final approval of all providers even when they delegate the task to outside vendors. They are also responsible to continuously monitor network physician and provider performance so that a quality network is maintained.

The issue brief also outlines URAC's proposed new standards module for transparency in provider performance measurement. Regulatory interest in evaluating network tiering practices is on the rise, punctuated by the recent settlement statement by New York's Attorney General which sets out new parameters for the way that state's health plans can equitably measure and report physician performance. URAC's proposed module provides a means for accredited organizations to demonstrate necessary transparency in performance benchmarking practices.

The brief, "URAC's proposed revisions for health plan, health network standards answer market outsourcing trend and demands for measurement," can be downloaded by visiting URAC's web site at http://www.urac.org/savedfiles/JuneNewswebHealthNetworks.pdf

About URAC

URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit http://www.urac.org.


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