URAC Requirement

URAC requires that validators evaluate the pharmacy organization’s reported measures for overall data accuracy, missing information, invalid fields, implausible fields (e.g., range checks), demographic errors, stratification (if applicable), and other data aggregation failures. This validation step is accomplished by performing a process to reasonably extract and validate a source sample from the pharmacy organization reported measures.

For this validation sampling, validators must obtain and examine documentation from the primary source system for a sample from the reported measures. The validator will review source documentation from the pharmacy organization’s reporting platforms, identify any inaccuracies from the URAC reporting instructions, and work with the pharmacy organization to resolve them. Substantive issues where there are, for example, material (e.g., >10%) inaccuracies must be investigated and resolved. If organizations are unable to correct issues materially impacting the final rates, a material finding will result.

HDC’s Process

HDC is proud to announce that it is one of only four vendors nationally who will be able to perform URAC validations. HDC will review the data collection and monitoring processes that enable the pharmacy organization to report the measures. The HDC validation encompasses multiple components, including review of the pharmacy organization’s Information Systems Capacity Assessment (ISCA), submitted rates, sampling and a site visit. A final determination of individual measure compliance / non-compliance with URAC reporting instructions will be established at the conclusion of the validation. HDC’s findings and final approved rates will be submitted to the pharmacy organizations and to URAC in HDC’s final Measure Data Validation Report.

Elements include:

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