Medicare Advantage Health Plan Module , Version 3.0 MA MRG PR02: CONSULTATION WITH PHYSICIANS AND SUBCONTRACTED PHYSICIAN GROUPS

This CMS standard provides:

The MAO must establish a formal mechanism to consult with the physicians and subcontracted groups that have agreed to provide services regarding the organization’s medical policy, quality improvement programs, and medical management procedures.

URAC supports this standard through a combination of network management standards, reviewed elsewhere in this training, requiring a formal strategy to involve participating providers on clinical and payment related committees.  In addition, URAC's delegation standards and HUM standards encouraging communication with participating providers provide all the necessary support.  You have already received training in those that apply to your role in the organization.