Utilization Reviews

URAC Accreditation for Health Utilization Management

Maximus is committed to clinical excellence. This is demonstrated by achieving Utilization Review Accreditation Commission (URAC) accreditation for Health Utilization Management (HUM), ensuring our company's systems, processes, and performance comply with national-recognized healthcare standards and best practices.

URAC is the independent leader in promoting healthcare quality by setting high standards for clinical practice, consumer protections, performance measurement, operations infrastructure, and risk management.

The HUM accreditation is one of many earned across the Maximus portfolio, including as a Credentials Verification Organization, Independent Review Organization, and Workers' Compensation Utilization Management.

Click here to learn more about our certifications and accreditations
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Comprehensive Utilization Review Services

Every state’s goals and initiatives are to promote placement in the least restrictive, least resource-intensive level of care necessary to meet individuals’ needs. With methods based on these principles, Maximus delivers gold standard, evidence-based Utilization Review (UR) services for a variety of state programs and a diverse range of populations, age groups, and diagnoses. Our UR methodologies are tailored for each state to accommodate unique participation criteria, provider standards, and other measures important to oversight agencies.

Up to 75%

enhanced federal matching for qualifying utilization reviews

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Processes and systems recognized by CMS

Our customized electronic screening tool offers a substantial cost savings and efficiency measures for states and providers by enabling around-the-clock, data-driven utilization review decisions. Using our processes and systems, states have fast results in determining support needs and appropriate levels of care, and they have immediate access to monitor the quality of provider services and their treatment practices.

With our designation as a Quality Improvement Organization-like (QIO-like) Entity by the Centers for Medicare and Medicaid Services, states contracting with Maximus on UR activities receive enhanced federal matching incentives (up to 75%) for qualifying utilization review and quality of care initiatives.

QIO-like Entity

CMS designates Ascend a Quality Improvement Organization-like Entity

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