WOODLAND HILLS, Calif., July 27 Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company announced today that they have been awarded full accreditation status for Health Utilization Management (HUM) standards from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. URAC HUM Standards ensure that all types of organizations conducting utilization review follow a process that is clinically sound and respects patients' and providers' rights.
"Anthem's staff of nurses, physicians and other key associates are very proud of the recognition that this full accreditation status represents. URAC is a highly respected national leader in promoting health care quality through its accreditation and certification programs. It symbolizes a level of excellence for our organization and validates our commitment to quality and accountability, and reflects our overall strategy of delivering increased healthcare value to our members" expressed Julie Theodore, R.N., Regional Vice President, Medical Management Operations.
Anthony Nguyen, Anthem's senior vice president of care management added, "Anthem's Utilization Management units are committed to "improving the lives of the people we serve and the health of our communities" by providing high quality care coordination. Our work includes assisting members and health care providers with discharge planning needs as well as the review of inpatient and outpatient service requests for pre-service and concurrent review. In addition, retrospective reviews are performed for inpatient service requests."
"By applying for and receiving Health Utilization Management accreditation, Anthem Blue Cross and Anthem Blue Cross Life and Heath Insurance Company have demonstrated a commitment to quality health care," said Alan P. Spielman, URAC president and CEO. "Quality health care is crucial to our nation's welfare and it is important to have organizations that are willing to measure themselves against national standards."
URAC's Health Utilization Management standards address, but are not limited to:
URAC, an independent, nonprofit organization, is a leader in promoting health care quality through accreditation and certification programs. URAC's standards keep pace with the rapid changes in the health care system, and provide a mark of distinction for health care organizations to demonstrate 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 setting meaningful standards for the health care industry. For more information, visit www.urac.org.
About Anthem Blue Cross
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. (® )ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.
-- Medical necessity criteria that is evidence based and promotes consumer safety; -- Specialty matched clinical peers for medical necessity review; -- Requirements for consistency in maintaining the highest confidentiality in UM processes as we approach a new age with electronic health records (EHR) and health information exchanges;
SOURCE Anthem Blue Cross