Beacon Health Strategies is an NCQA-accredited managed behavioral health organization (MBHO). Full accreditation is granted for three years to those plans that meet NCQA’s rigorous standards for continuous quality improvement. Beacon is also accredited by URAC for case management and health utilization management.
What is the National Committee for Quality Assurance (NCQA)?
NCQA is is an independent, not-for-profit organization, whose mission is to improve the quality of America’s healthcare. Through both on-site and off-site evaluations, an NCQA team of physicians and managed care experts evaluates how well a health plan manages all parts of its delivery system – physicians, hospitals, other providers and administrative services.
What is reviewed as part of NCQA’s accreditation process?
There are approximately 60 standards for quality that range from credentialing to members’ rights to quality management and improvement.
What is the Utilization Review Accreditation Commission (URAC)?
URAC is a nonprofit organization whose mission is to promote continuous improvement in the quality health care management through accreditation and education. Organizations participate in a process that entails a review occurring in four phases, covering a period of approximately three to six months. Applicants who meet all requirements are awarded a full two-year accreditation.
What services are Beacon Health Strategies accredited for by URAC?
URAC has accredited Beacon for both its case management and health utilization management (UM) services. Its case management standards range from staff structure and organization to information management to organizational ethics.
Its UM standards build on the core accreditation standards and establish consistency and maintain the highest confidentiality in UM processes. URAC UM accreditation requires each organization to implement a three-step process to determine whether a proposed medical treatment or service is medically necessary: Initial Clinical Review, Peer Clinical Review and Appeals Consideration.