Mountain State Blue Cross Blue Shield (Mountain State) was recently awarded both the Case Management Accreditation and Health Utilization Management Accreditation from the Utilization Review Accreditation Commission (URAC), a Washington, DC-based healthcare accrediting organization that establishes quality standards for the healthcare industry. These accreditations are in addition to the award received by Mountain State in December, 2004 for their HIPAA Privacy Accreditation Covered Entity and Business Associate programs.

URAC's Case Management Accreditation standards address approaches to ensuring appropriate patient protections have been established, such as policies for confidentiality of patient information, informed consent, dispute resolution and other issues. The standards cover staff structure and qualifications, quality improvement, information management, oversight of delegated functions, ethics, complaints, and the case management process.

The URAC Health Utilization Management standards establish consistency in UM processes. The standards ensure that appropriately trained clinical personnel conduct and oversee the utilization review process, that a reasonable and timely appeals process is in place, and that medical decisions are based on valid clinical criteria.

"Mountain State is honored to receive these accreditations from URAC," said Gregory K. Smith, Mountain State's President and CEO. "We are very pleased to be recognized in the industry for providing outstanding services. Such a distinction also underscores the quality of our work with customers, patients, clients, payors, and providers by demonstrating compliance with national standards."

URAC, an independent, nonprofit organization, is a leader in promoting healthcare quality through accreditation and certification programs. URAC's standards keep pace with the rapid changes in the healthcare system, and provide a mark of distinction for healthcare 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 healthcare industry. For more information, visit www.urac.org.