URAC releases new claims standards, announces CEO departure

URAC, a Washington-based healthcare measurement association, has released its revised claims processing accreditation standards. The organization also announced that Alan Spielman, its president and CEO, will leave his post Feb. 15.

The new standards are said to be a reflection of new industry trends and government regulations and were completed after a public comment period this summer. The organization also split the program to include standards for health plans and health plan vendors and separate standards for third-party administrators—such as pharmacy benefit managers—that provide business operations but not clinical review or appeals.

"Under these regulations, organizations are required to implement operating rules aimed at achieving greater uniformity with the transmission of health information," Spielman said in a news release. "These modifications are designed to promote more efficient electronic data exchanges, enable providers and payers to process financial and administrative transactions expeditiously and facilitate cost containment."

Spielman joined URAC in late 2005 after the departure of Garry Carneal.

Spielman said in a news release that many of the goals he had set for URAC had been met or are within reach, so he decided "now is the time for me to move on to new pursuits." Beginning next year, URAC, formerly the Utilization Review Accreditation Commission, will be one of two national accreditation entities for health insurance exchanges.

The URAC board of directors has formed a search committee to find a replacement for Spielman.