URAC Health Network Accreditation — Frequently Asked Questions

What is URAC Health Network Accreditation?

URAC Health Network Accreditation is an independent, third-party quality designation for health networks — including PPOs, behavioral health networks, specialty medical networks, physician-hospital organizations, and workers' compensation networks. It validates that a network meets nationally established standards for credentialing, provider oversight, quality management, and consumer protection. URAC awards accreditation for a three-year cycle.

What types of organizations are eligible?

Eligible organizations include:

• Preferred provider organizations (PPOs)
• Provider-based network models
• Behavioral health networks
• Specialty medical networks (radiologists, audiologists, physical therapists, optometrists, long-term care providers)
• Physician-hospital organizations (PHOs)
• Chiropractic networks
• Workers' compensation networks

Is URAC Health Network Accreditation required by law?

There is no universal federal mandate requiring health network accreditation. However, accreditation is frequently required or strongly preferred by commercial payer contracts, self-insured employer groups, and state regulatory frameworks. Some states reference URAC accreditation in managed care or specialty network licensure requirements. Organizations operating in multiple states often pursue accreditation as a baseline compliance strategy.

What are the core standards areas?

The program covers five primary domains:

1. Credentialing and Recredentialing — primary source verification, credentialing committee oversight, application timelines, consumer safety investigations
2. Network Management and Oversight — governance, access and availability standards, delegated entity oversight
3. Quality Management — data collection, performance metrics, improvement programs
4. Consumer Protections — confidentiality, complaint and grievance handling, dispute resolution
5. Regulatory Compliance — alignment with applicable state and federal requirements, risk management protocols

How long does URAC Health Network Accreditation last?

URAC awards Health Network Accreditation for a full three-year cycle. Organizations must pursue reaccreditation before the cycle expires to maintain their accredited status.

How long does the accreditation process take?

Most organizations plan for 6–12 months from initial gap analysis to accreditation decision, depending on readiness at the outset. URAC conducts its independent assessment within six months of a completed application submission. Organizations with mature credentialing and quality management infrastructure tend toward the shorter end; those building from a lower baseline typically need more time for policy development and evidence preparation.

What is involved in the URAC application process?

The process generally involves:

• Reviewing URAC standards and conducting a gap analysis against your current operations
• Developing or updating policies, procedures, and program documents to meet applicable standards
• Organizing evidence mapped to each standard
• Submitting a completed application to URAC
• Responding to any Requests for Information (RFIs) from URAC reviewers during the assessment

IHS supports organizations through each of these phases.

What is a URAC Request for Information (RFI)?

During the review process, URAC reviewers may issue Requests for Information (RFIs) when submitted evidence is unclear, incomplete, or raises questions about compliance with a specific standard. Organizations must respond to RFIs within URAC's specified timeframe. Effective RFI responses address the reviewer's specific concern with standards-precise language and additional evidence — not simply restating what was already submitted. IHS prepares and reviews RFI responses as part of its accreditation engagements.

What is credentialing delegation and why does accreditation matter for it?

Credentialing delegation occurs when a health plan authorizes a downstream network to conduct credentialing on its behalf, rather than requiring each plan to independently credential every provider. URAC Health Network Accreditation is frequently a prerequisite for a health plan to grant credentialing delegation. Without accreditation, networks may be required to submit to separate audits from every contracting plan — a significant administrative burden that accreditation eliminates or substantially reduces.

How is URAC Health Network Accreditation different from NCQA network accreditation?

Both URAC and NCQA are nationally recognized accrediting bodies with standards covering credentialing and network quality. URAC's Health Network Accreditation is specifically designed for a broad range of standalone network models — PPOs, specialty networks, behavioral health networks, PHOs. NCQA's network-related accreditation is more tightly integrated with health plan accreditation and tends to apply to organizations with financial accountability and enrollment functions. The right program depends on your organization's structure, payer requirements, and state market. Some organizations pursue both.

What does URAC's non-prescriptive standards framework mean in practice?

URAC standards define what outcomes and operational practices a network must achieve, but do not dictate how the organization must achieve them. This means a network can meet URAC standards through its existing workflows and systems — provided it can document that those workflows produce the required outcomes. The practical implication: organizations with strong existing operations often need less structural change than they expect; the primary work is documentation, evidence organization, and filling genuine gaps.

What common challenges do health networks face during accreditation?

The most common challenges are:

1. Credentialing documentation gaps — primary source verification records that are incomplete or inconsistently maintained
2. Policy-practice misalignment — written policies that do not reflect what the organization actually does operationally
3. Delegated entity oversight — insufficient documentation of oversight mechanisms for delegated credentialing or other functions
4. Quality management program development — networks that handle credentialing well but lack a formal quality improvement structure
5. RFI response quality — responding to reviewer questions with vague or non-specific answers that do not resolve the underlying concern

Can IHS help with reaccreditation as well as initial accreditation?

Yes. IHS supports both initial accreditation engagements and reaccreditation cycles. Reaccreditation involves demonstrating sustained compliance and continuous improvement since the prior cycle. Organizations that have maintained their programs well between cycles typically have a more streamlined reaccreditation process; those that have allowed documentation or practices to drift may require more intensive preparation. IHS also offers ongoing maintenance support between cycles to minimize reaccreditation burden.

What makes IHS different from other URAC accreditation consultants?

The founding principal of IHS, Thomas G. Goddard, JD, PhD, served as Chief Operating Officer and General Counsel of URAC before founding the firm. That means IHS brings insider knowledge of how URAC standards are written, interpreted, and applied during review — not just familiarity with the standards text. IHS also takes a principal-led engagement model: the senior expert is directly involved in your organization's work, not delegated to junior staff.

How do I get started?

The first step is a free discovery session. IHS will discuss your network type, current operational state, accreditation drivers, and target timeline. From that conversation, IHS develops a scoped proposal specific to your organization's situation. Engagement scope and investment are scoped per engagement — contact IHS for a proposal.