Effective July 1, 2018, SB1160 requires all Utilization Review Organizations to obtain URAC Accreditation in Utilization Management. URAC is an independent, non-profit accreditation entity, whose mission is to advance healthcare quality through leadership, accreditation, measurement, and innovation. URAC was founded in 1990 as an independent, third party healthcare quality validator. PDI received re-accreditation in May of 2018.
URAC Standards URAC accreditation Utilization Review Organizations must demonstrate that they: • Employ drug utilization management mechanisms to address therapeutic appropriateness, over and underutilization, dosage, duration of treatment, duplication, drug allergies, and more • Provide an independent, unbiased determination of medical necessity beginning with an initial clinical review, then moving to a peer clinical review if needed • Is prepared to address any risk to patient safety, such as contraindicated treatments, adverse drug interactions, or inappropriate treatment, during the review process • Adhere to time frames outlined in the standards for urgent and non- urgent review determinations • Understand and adheres to applicable state and federal regulations for Workers’ Compensation programs