Accreditation of a Health Plan Essay Paper

Accreditation of a Health Plan Essay Paper

Accreditation Of A Health Plan

Accreditation is a voluntary non-governmental program in which trained external peer reviewers evaluate a healthcare organization’s compliance and compares its pre-established performance. Accreditation of a Health Plan Essay Paper

The National Committee For Quality Assurance

The national committee of quality assurance is a non-profit organization established to improve quality healthcare through programs, measures, standards, and accreditation. This program manages accreditation for physicians, health plans, and medical groups. According to the national committee of quality assurance, it is the only accreditation that uses comprehensive evaluation of health plans in the nation and its accreditation scores are based on the actual results and a set of clinical measures and consumer experience (Greene, et al, 2017). In the healthcare setting, insurance companies need to meet the requirements set by the NCQA that are utilization management, quality management and improvement, member’s rights and responsibilities, and member’s connections. NCQA is different from URAC because it focuses on the actual results while the URAC focuses on maintaining the standards of quality healthcare Accreditation of a Health Plan Essay Paper


Utilization Review Accreditation Committee URAC

URAC is a non-profit organization established to help promote health care quality through the accreditation of organizations involved in medical care service and offer training and measurement programs (Bean, et al, 2020). URAC accreditation is given to organizations such as provider organizations, pharmacies, and health plans. It also offers accreditation to individual physicians based on the core standards in education ethics, licensure, and practical operations. It is usually given for three years in which the organization and the individual should go through the review after the period expires to maintain the accreditation status. URAC is different from other accreditation companies because it has set high standards in the dynamic healthcare system to provide and provides a distinction for healthcare organizations to demonstrate quality and accountability. It conducts its business in a manner that meets the predetermined criteria with the national standards. Accreditation of a Health Plan Essay Paper


Bean, M., Erdil, M., Blink, R., McKinney, D., & Seidner, A. (2020). Utilization Review in Workers’ Compensation: Review of Current Status and Recommendations for Future Improvement. Journal of Occupational and Environmental Medicine62(6), e273-e286.

Greene, A. M., Bailey, C. R., Young, M., Wolfgang, E., Tekes, A., Huisman, T. A., & Durand, D. J. (2017). Applying the National Committee for quality assurance patient-centered specialty practice framework to radiology. Journal of the American College of Radiology14(9), 1173-1176. Accreditation of a Health Plan Essay Paper

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