URAC Seeks New Leader and Revamps Claims Processing Accreditation

Health care accreditation firm URAC has announced a search for a new leader and revisions to its claims processing accreditation standards.

Alan Spielman, president and CEO, will leave the Washington-based organization on February 15 after seven years of service. With many goals met or within reach, URAC is well-positioned to serve the industry as health care reform provisions are implemented, he said in a statement. “As a result, I have decided that now is the time for me to move on to new pursuits.” The board has created a search committee for a new leader.

To better align with provisions in the health reform law, URAC has split its claims processing accreditation program into two separate programs. One program is for organizations that process claims but do not handle clinical review and appeal functions, such as third-party administrators and pharmacy benefit managers. The second program is for claims processors that also have claims review and appeals business operations, such as TPAs, health plans and health plan vendors.

URAC also has expanded claims processing security requirements to include having a security officer, a security management process, written business associate agreements, access and audit controls, interoperability and risk assessment analyses with pre-implementation testing, and breach handling duties.