NCQA Health Plan Accreditation Updates for 2023
NCQA Health Plan Accreditation program provides a framework for assessing the quality of health plans and ensuring that they meet certain standards.
NCQA Health Plan Accreditation: 5 Reasons for Third-Party Review
NCQA Health Plan Accreditation is a rigorous evaluation process that assesses the quality of health plans and their ability to meet the needs of their members. As part of the accreditation process, NCQA requires health plans to undergo third-party review.
URAC Accreditation Consulting: Worth the Investment?
URAC accreditation consulting valuation begins with seeing the importance of earning a credential. The multifaceted world of accreditation can be daunting, from choosing the right accreditation body to getting correct documentation in place to ensure accreditation success.
Independent Review Organization Benefits for Payers, Providers, and Patients
An Independent Review Organization (IRO) deliver independent medical peer review services designed to ultimately reduce administrative costs and ensure patients receive proper treatments. Rising healthcare costs affect millions of people daily. Providers and insurers can rely on IROs to help them to control costs and offer affordable coverage.
BHM Earns URAC Accreditation as IRO
BHM announced that it has been awarded re-accreditation as an Independent Review Organization from URAC
Levels of Care Impact Medical Necessity Review Success
Level of Care Guidelines are usually derived from generally accepted standards of behavioral health practice. These standards include guidelines and consensus statements produced by professional specialty societies, as well as guidance from governmental sources such as CMS’ National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
Care And Cost Containment
Any serious discussion of patient care and cost containment must include a discussion about utilization review and management. Sometimes these two terms are used interchangeably, while their meanings and processes are quite different in reality.
Tips for Shifting to a PCMH Model
Patient Centered Medical Homes (PCMH) value based care model growing across the United States. PCMHs aren’t actually places but care models based on providing care which is accessible, coordinated, and comprehensive. PCMHs focus on patient centered care and are committed to quality and safety.
7 Ways to Lower First-time Accreditation Risk
The multifaceted world of accreditation can be daunting, from choosing the right accreditation body to getting correct documentation in place to ensure accreditation success. Here are 7 tips to keep you on track and lower first time accreditation risk.
Independent Review Organization Can Save You Money 3 Ways
The role of the Independent Review Organization (IRO) in the appeals process is to provide an unbiased 3rd party opinion on complicated reviews, helping to assure that all reviews are given the time and care they deserve. It’s a common illusions in the healthcare industry that taking care of things in house is the best and easiest way to save money—however this isn’t true when it comes to claim reviews. If you are trying to manage your denials in-house, it can actually be counterproductive if you’re trying to save money and even time. Let’s take a look at how outsourcing your IROs can save you time and money.