Salt Lake City, Utah, September 22, 2010 — HealthCare Insight (HCI) announced today that it has been awarded full accreditation in HIPAA Privacy for Business Associate and Health Utilization Management (HUM) modules from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the health care industry.
“For two decades, URAC has led the effort to ensure the highest standards in healthcare,” noted HCI President Dr. Barry Johnson. “That we have received URAC’s widely respected accreditation in these two areas underscores our commitment to upholding those standards and industry best practices. And more importantly, it demonstrates to our clients our dedication to serving them with highly reliable benefit decision recommendations that help them prevent fraud, waste, and overpayment.”
URAC President and CEO Alan P. Spielman added, “HealthCare Insight should be commended for meeting strict quality standards. It is critically important for health care organizations to make a commitment to quality and accountability. URAC accreditation is a demonstration of that commitment.”
The HIPAA Privacy for Business Associate module displays HCI’s commitment to secure information practices and demonstrates that it takes all the steps necessary to protect health information privacy in accordance with the HIPAA Privacy Rule.
Accreditation in the Health Utilization Management module confirms that HCI employs a claims review process that meets a long list of rigorous requirements set forth by URAC. HCI’s claims review process, based on recognized rules with interpretation and validation by clinicians, protects the rights of providers and patients.
The URAC accreditation process lasted more than a year and entailed the compilation of extensive documentation, the formalization of internal processes, and submittal to a rigorous site inspection in demonstration to URAC reviewers that HCI meets their high benchmarks.
About HealthCare Insight
HealthCare Insight (HCI), a division of Verisk Health, serves private and public healthcare payors with a new and continually evolving kind of fraud, abuse, and overpayment prevention service. HCI prepayment detection software spots suspect claims and billing patterns in real time through a streamlined software-as-a-service (SaaS) model. It routes flagged claims for validation by experienced clinicians — physicians, registered nurses, dentists, etc. — and seasoned investigators. The result is a high-tech, high-touch process that helps payors make the right payment for the right service to the right provider.
URAC, an independent, nonprofit organization, is well known as a leader in promoting healthcare quality through its accreditation, education, and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the healthcare 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 healthcare industry. For more information, visit www.urac.org.