URAC Health Care Management Certification — Frequently Asked Questions
Last updated: April 2026
Answers to the most common questions about URAC Health Care Management (HCM) Certification — what it is, who needs it, how the process works, and what challenges organizations face. From IHS, a specialized healthcare accreditation consulting firm led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC.
About URAC HCM Certification
What is URAC Health Care Management Certification?
URAC Health Care Management (HCM) Certification: a three-year quality credential awarded by URAC (Utilization Review Accreditation Commission) to healthcare organizations that operate in the healthcare industry but do not meet the eligibility requirements for URAC's program-specific accreditations — such as Case Management, Health Utilization Management, or Pharmacy Benefit Management.
HCM Certification evaluates organizations against URAC's four Foundational Focus Areas: Risk Management, Operations and Infrastructure, Performance Monitoring and Improvement, and Consumer Protection and Empowerment. These are the same structural domains underlying most URAC accreditation programs — applied here as a stand-alone credential for organizations whose scope does not fit within a single program category.
Who is eligible for URAC HCM Certification?
Any organization that (1) operates in the healthcare industry and (2) does not qualify for another URAC accreditation or certification program may apply. URAC does not certify or accredit individuals — HCM Certification applies to organizations only.
Common applicants include:
- Healthcare technology and analytics vendors
- Subcontracted health operations companies performing delegated functions for health plans or MCOs
- Care coordination platforms without a discrete clinical program
- Specialty administrative service organizations (disease management logistics, wellness program administration, complex care navigation)
- Health plan support organizations (quality improvement, compliance monitoring, regulatory reporting)
- Emerging healthcare service organizations whose scope spans multiple URAC program categories
What is the difference between URAC accreditation and URAC HCM Certification?
URAC accreditation programs — Case Management, Health Utilization Management, Patient Care Management, Pharmacy Benefit Management, and others — are designed for organizations that operate specific clinical or administrative programs with a defined scope and corresponding standard set.
HCM Certification is designed for organizations that operate in healthcare but whose scope does not fit within an existing URAC program category. Both HCM Certification and program-specific accreditations are awarded for three-year terms. The Foundational Focus Area standards underlying HCM Certification are the same structural backbone that anchors program-specific accreditations — HCM Certification applies them in a stand-alone context for organizations that need external validation without a program-specific credential.
Standards and Scope
What do the URAC HCM Certification standards cover?
HCM Certification standards are organized into four Foundational Focus Areas:
- Risk Management — organizational governance, security and privacy programs, business continuity, and incident management. Surveyors evaluate documented risk processes, security protocols for protected health information, and tested continuity plans.
- Operations and Infrastructure — policies and procedures governing core operations, staffing qualifications and oversight, delegation management for subcontracted functions, and ongoing training. This is typically the heaviest documentation area — URAC expects policies that reflect actual operations, with evidence of staff training and operational adherence.
- Performance Monitoring and Improvement — quality management program structure, performance measure selection and tracking, data analysis, and documented improvement actions. A functioning QM system is required — not a plan on paper, but an operational process that produces measurable results.
- Consumer Protection and Empowerment — consumer safety protocols, complaint and grievance processes, health literacy requirements for consumer-facing materials, and escalation pathways. Organizations that touch consumer-affecting processes indirectly are not exempt from these requirements.
Does URAC prescribe how organizations must meet the HCM Certification standards?
No. URAC convenes experts to define the standards of excellence — what must be demonstrated — but does not prescribe how organizations must meet those standards. This flexibility is an asset for organizations with innovative operating models that do not fit prescriptive program templates. It is also where organizations without consulting support struggle: the flexibility requires the organization to interpret the standard and build an appropriate compliance framework, rather than following a prescribed template.
Does HCM Certification satisfy state regulatory requirements?
URAC's program-specific accreditations (such as Health Utilization Management v8.2) fulfill state regulatory requirements in 13 states. HCM Certification is a general quality credential — not the equivalent of program-specific accreditations for state regulatory purposes. Organizations pursuing HCM Certification for state regulatory compliance should confirm with their state regulator whether HCM Certification satisfies the specific requirement. IHS advises organizations on state-specific regulatory credential requirements and helps identify the right credential for the regulatory context.
Process and Timeline
How long does URAC HCM Certification take?
URAC markets the HCM Certification process as taking less than six months. With IHS consulting support — gap analysis, policy development, mock survey, and AccreditNet submission — most organizations complete the process within five to six months. The timeline is faster than program-specific URAC accreditations because the Foundational Focus Area standards are narrower in scope and the look-back period requirements are less extensive than in programs such as Case Management (v7.0) or Health Utilization Management (v8.2).
What is the URAC HCM Certification process?
- Standards acquisition — Purchase HCM Certification standards from the URAC store. IHS advises on the specific standards package applicable to the organization's operational context.
- Gap analysis (Standard-by-Standard Review) — IHS evaluates the organization's policies, procedures, and operations against each HCM Certification standard, producing a prioritized remediation roadmap.
- Policy development and process engineering — IHS drafts or revises compliance documentation: policies, procedures, job descriptions, delegation agreements, quality management documentation, consumer communication templates. The organization begins operating under new procedures immediately to build operational evidence.
- Mock survey — IHS conducts an internal review simulating the URAC survey process, including staff interviews. Remaining gaps are identified and remediated before AccreditNet submission.
- AccreditNet submission — Documentation is assembled and uploaded to URAC's AccreditNet platform, organized with clear standard-by-standard mapping.
- URAC review and RFI response — URAC's review team evaluates the submission. IHS drafts all RFI responses.
- Certification award — URAC awards HCM Certification for three years. IHS provides guidance on maintenance and renewal requirements.
Does HCM Certification have a look-back period requirement?
HCM Certification requires operational evidence — URAC surveyors evaluate whether organizations are actually operating in compliance with standards, not just whether policies exist on paper. However, the look-back period requirements for HCM Certification are generally less extensive than those for program-specific accreditations such as Case Management (which requires months of documented longitudinal operations). IHS advises organizations on the specific operational evidence requirements during the initial gap analysis.
What is the URAC AccreditNet platform?
AccreditNet is URAC's online submission and review portal. Organizations upload all required compliance documentation — policies, procedures, quality management documentation, delegation agreements, and supporting evidence — to AccreditNet for review by URAC's survey team. IHS organizes submissions with standard-by-standard mapping and cross-references for documentation satisfying multiple standards, which reduces RFI volume and accelerates review timelines.
What is a URAC Request for Information (RFI)?
A URAC RFI is issued by URAC's review team when submitted documentation does not fully satisfy a standard — reviewers seek additional documentation or clarification. RFIs are a normal part of the URAC review process. IHS drafts all RFI responses for client organizations, providing evidence-backed documentation that directly addresses each reviewer concern. Thorough mock surveys and well-organized initial submissions significantly reduce RFI volume.
How often must HCM Certification be renewed?
URAC awards HCM Certification for a three-year term. At the end of the three-year cycle, organizations must pursue renewal to maintain certified status. The renewal process follows the same general structure as initial certification. URAC may update the Foundational Focus Area standards between cycles; IHS monitors standard updates and advises clients on changes that affect their compliance posture.
Challenges and Common Issues
What are the most common reasons organizations fail URAC HCM Certification?
The most consistent failure modes across HCM Certification reviews:
- Policies that do not reflect actual operations. URAC surveyors interview staff and look for evidence of operational compliance, not just written policy. The gap between written policy and observed practice is the single most common source of adverse findings and RFIs.
- Quality management systems that exist only on paper. The Performance Monitoring and Improvement standards require functioning committees, documented performance data, and evidence of corrective actions taken in response to identified deficiencies. A QM Plan without operational infrastructure behind it fails this domain.
- Delegation oversight gaps. Organizations that subcontract functions often underestimate the documentation requirements for ongoing delegation oversight. Periodic audits, documented issue identification, and corrective action tracking are required — executed delegation agreements alone are insufficient.
- Consumer communication deficiencies. Health literacy requirements, complaint process documentation, and escalation pathway requirements are frequently underestimated — particularly by organizations that touch consumer-affecting processes indirectly.
- Security documentation gaps. Organizations with strong security practices but minimal documentation face RFIs in the Risk Management domain. The issue is not security posture — it is the absence of documented evidence reviewers can evaluate.
Can an organization with no prior URAC experience pursue HCM Certification?
Yes. HCM Certification does not require prior URAC accreditation or prior certification history. Many first-time URAC applicants begin with HCM Certification — either because their current operational scope qualifies them for HCM rather than a program-specific accreditation, or because they are building toward a program-specific credential and want to establish a URAC quality baseline first. IHS works with organizations at every stage of URAC experience, including first-time applicants with no prior URAC history.
Working with IHS
What role does IHS play in the HCM Certification process?
IHS serves as the organization's full-cycle consulting partner — from initial gap analysis through certification award. Services include:
- Standard-by-Standard Review producing a prioritized gap and remediation report
- Policy and procedure development aligned to actual operations
- Quality management program documentation
- Delegation agreement review and oversight documentation frameworks
- Consumer communication template review and revision
- Mock survey with staff interviews and documentation review
- AccreditNet submission organization and upload
- RFI response drafting
- Renewal cycle planning and ongoing compliance guidance
How does IHS differ from other URAC consulting firms?
Thomas G. Goddard, JD, PhD served as the former Chief Operating Officer and General Counsel of URAC — he helped develop the standards framework that HCM Certification draws from. He knows how URAC surveyors evaluate documentation, what constitutes sufficient operational evidence, and where organizations predictably fall short. Every IHS engagement is led by or under his direct oversight. This is not a general compliance consulting approach — it is consulting from someone who was on the other side of the table when these standards were built.
How do I get started?
Every IHS engagement begins with a discovery conversation to assess organizational readiness, confirm credential fit, and scope the consulting engagement. There is no cost to the initial conversation.