TRISTAR's URAC accreditation renewal for Workers' Compensation Utilization Management was successful. URAC is a nationally recognized organization that sets the standard for the highest level of utilization review quality. Unlike previous years, the renewal process was virtual. The application, submitted in April by TRISTAR's audit team, passed with a score of 100%, ensuring TRISTAR's URAC recertification for another three years.
The URAC's Workers' Compensation Utilization Management Accreditation infrastructure requires that TRISTAR meet 40 specific core standards of best in class health care operations across the following areas, including:
- Organizational Structure
- Policies and Procedures
- Regulatory Compliance
- Delegated Functions
- Marketing and Sales
- Information Management
- Quality Management
- Staffing and Oversight
- Consumer Rights, Safety, and Satisfaction
The three-year accreditation also includes standards for service accessibility, initial screenings, clinical review, decision timeframes, utilization policy, appeals, and more.
"This is the second time the medical management team received a 100% audit score," said Mary Ann Lubeskie, Vice President of Managed Care. "URAC sets the highest standards for injured worker safety and quality of care. To achieve these high standards is a reflection of the great work our UR team provides," added Pam Guiles, Vice President of Operations for Medical Management.
Workers' Compensation coverage protects both employees and employers in the event of a workplace injury or related illness. While the long-term impact of COVID-19 on workers' compensation claims is still unknown, what remains constant is the need to ensure patient safety and quality care while containing spiraling medical costs. During these unprecedented times, the utilization management (UM) process has become even more critical.
URAC's Workers' Compensation Utilization Management Accreditation shows our ability to abide by the gold standard when performing utilization review. It also demonstrates TRISTAR's commitment to quality and adherence to nationally recognized guidelines. Call TRISTAR at 1.888.558.7478 to learn more about how our Utilization Review and Managed Care service can help your business.
