URAC Requirement

The Utilization Review Accreditation Commission (URAC) requires that all accredited pharmacies undergo independent auditing by a pre-approved audit firm. The auditor will verify the integrity of reported measures through random sampling of source system data, and will test for missing information, invalid fields, implausible data, demographic errors, and other data aggregation failures. The auditor will submit a final report to URAC to demonstrate the sampling and the results.

HDC’s Process

HDC is proud to announce that it is one of only four vendors approved by URAC to perform the pharmacy audits. HDC will evaluate the data collection and methodologies that enable the pharmacy to report the measures. HDC’s process encompasses multiple components, including review of the pharmacy’s Information Systems Capacity Assessment (ISCA), submitted rates, data testing and a site visit for source system demonstrations. HDC guides the pharmacy with experienced auditors and proprietary tools. The process is entirely collaborative: The auditor will work with the pharmacy-client to understand anomalies, assess impact and identify a solution. HDC’s findings and rate results will be submitted to the pharmacy and to URAC in the Final Validation Report at the end of the process. HDC staff remain available throughout the year to answer any questions that a pharmacy-client may have.

Elements include:

  1. Source/Transaction Systems Review
  2. Source Code Review
  3. ISCA Review
  4. Validation Sampling
  5. Benchmarking
  6. Site Visit
  7. Final Validation Report