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Using URAC to Curb Denials and Appeal Claims
If you are having trouble getting timely decisions from insurance carriers, URAC has established standards for
excellence in timely utilization review and has a number of important protections for patients and physicians.
Read this entire article for information on using URAC in your appeals. |
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Featured Appeal Letters
The AppealLettersOnline.com Repository has
seven letters designed to assist providers with appealing claims based on lack of URAC compliance by a carrier. These letters directly quote URAC standards
related to requirements for peer-to-peer conversation subsequent to any denial, timely decision making on UR and appeal requests and specifications for
providing sufficient detail in written denials. There is also a letter which assists providers appeal overly broad medical records requests by the insurance
carrier. These letters make it easy to become a URAC compliance enforcer for your office and your
patients....access
the appeal letter repository |
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Featured URAC Websites
In addition to AppealLettersOnline, the following websites contain useful information about assessing insurers for URAC compliance:
URAC Program Overview. This link takes you directly to the URAC page which explains the UR accreditation program and lists the
carriers who have agreed to follow the standard.
http://www.urac.org/about_complaint1.asp.
Complaints filed with URAC regarding noncompliant
members will be investigated by URAC. Although URAC cannot resolve problems related to a health plan's determination of
benefits, URAC does have the authority to rescind the accreditation of noncompliant carriers. This leverage may assist you in dealing with noncompliant member organizations.
URAC Utilization Management Standards.
This site contains the complete URAC utilization management standards which accredited organizations must follow if they render
utilization management decisions. These are industry-wide standards for rendering quality UM decisions.
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