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Utilization Management Accreditation

Utilization management helps ensure that patients have the proper care and the required services without overusing resources. NCQA Utilization Management Accreditation helps guarantee that organizations making these decisions are following objective, evidence-based best practices.

A QUALITY IMPROVEMENT FRAMEWORK

With the increasing emphasis on reducing costs while improving patient outcomes, utilization management companies are taking on new importance. Using objective, evidence-based criteria, they evaluate requested health care services to make fair and timely determinations (on behalf of their clients) about the services’ appropriateness.

NCQA Utilization Management Accreditation provides a framework for implementing industry best practices to ensure:

  • Fair and timely utilization evaluations using objective, evidence-based criteria: 
    • Collection and use of relevant clinical information to make utilization management decisions.
    • Qualified health professionals assess requests and make utilization management decisions.
  • Alignment with state requirements.
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Why Utilization Management Accreditation?

  • Improve operational efficiencies

    Applying industry best practices improves the utilization management process:

  • Elevate your organization’s reputation

    Demonstrate the quality of your organization’s programs to employers, regulatory agencies, health plans and MBHOs.

  • Align with state requirements

    Adoption of industry best practices improves the likelihood that organization operations align with state requirements.

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