Managing managed care through accreditation standards.
Accreditation is emerging as a dominant strategy for ensuring accountability and basic quality of services in managed care organizations. Knowledge of accreditation standards can help social workers interact effectively with managed care companies when requesting services for clients and appealing denials. Familiarity with patient's rights protections, the appeals process, and provider credentialing guidelines can help protect social workers as well as clients from unfair decisions by managed care organizations. This article provides an overview of managed care accreditation standards and strategies for integrating this knowledge into advocacy efforts.
Neuman
Karen M
KM
Social Work Department, Madonna University, Livonia, MI, USA. kneuman@madonna.edu
Ptak
Margaret
M
D000068:Accreditation; D003406:Credentialing; D020793:Gatekeeping; D033183:Interdisciplinary Communication; D008329:Managed Care Programs / Q000592:standards*; D010344:Patient Advocacy; D012941:Social Responsibility; D012947:Social Work / Q000379:methods*; D014481:United States