Genex Services is a leader in utilization review (UR) and has an advanced position to meet the requirements of California Senate Bill 1160, particularly the accreditation mandate. The administrative director of the program will implement a process to select the independent, nonprofit organization that will perform accreditation, but until that time, URAC will serve as the accrediting body.
Genex has been accredited by URAC in Workers’ Compensation Utilization Management since 1996. To obtain this accreditation, Genex went through an in-depth and rigorous evaluation process that consisted of:
Since a considerable amount of time, effort and expertise is required to obtain URAC accreditation, there are concerns that many other UROs—which are currently unaccredited but serve the California WC market—will be unable to meet the accreditation requirement by the July 1, 2018 deadline. When a URO is starting from scratch, it can take a minimum of six months to a year to achieve URAC accreditation. However, many small and unsophisticated players may not have core standards in relation to their organizational structure, which may render them unable to meet URAC requirements. In other cases, UROs may not have the financial wherewithal to invest in IT infrastructure and procedural expertise to establish the comprehensive controls needed to become accredited.
As the state of California now recognizes, URAC accreditation provides a stamp of approval that a URO can perform UR based on a nationally accepted set of standards and best practices. As of January 2016, DWC reported that only 26 out of more than 60 UROs operating in California had attained URAC accreditation. A presentation by the RAND Corporation (dated 2/19/16) said that “accreditation would provide more assurance that the URO has the infrastructure and processes in place to comply with UR requirements.” Thus, insurers, employers and third-party administrators should begin to examine the UROs they work with in the California WC market to verify they have URAC accreditation or are well on their way to achieving it; otherwise, these UROs may fail to meet the requirement.
Genex has achieved URAC accreditation for so long now that it has begun to go beyond URAC requirements to pioneer new levels of excellence and quality assurance (QA):
Pioneering new standards of quality is part of Genex’s strategy to bring together the heart and science of medical management. By utilizing highly-specialized technology, physician expertise and evidence-based guidelines on every claim, Genex ensures injured workers receive appropriate care at the right time and in the right way.
Accreditation requirements may continue to evolve, based on the direction of the soon-to-beappointed administrative director. However, the advanced strategies that Genex has put in place position it to meet the ongoing needs of the California WC market, as well as the new and evolving requirements under SB 1160.
Topics: Utilization Review