URAC Core 14 -- Business Relationships

My colleagues and I have noticed, as have some veteran URAC reviewers to whom we've spoken lately, that some folks are still misinterpreting Core 14. Let me see what we can do to help sort out the confusion.

The standard reads: "The organization maintains signed written agreements with all clients describing the scope of the business arrangement."

"For which organizations does your organization work"? The answer to this question should guide your response to Core 14. The key to understanding this is to focus on what a "client" is. In "URACLand", a client is a company for which your organization performs services. If your company is an insurance plan for health coverage, "clients" may be employer groups, or the state if providing Medicaid services, or CMS if providing Medicare services. If your organization is a vendor, such as an independent review organization (IRO), your "clients" may be insurance companies, such as Blue Cross Blue Shield Plans.

This standard requires your organization to enter into written agreements with "clients" that describe the terms of the business arrangement. Requiring the terms of these business relationships to be in writing is a safeguard for your organization, as it ensures that the services you provide to an organization is not based on verbal agreements or a "gentleman's handshake", which could result in legal issues down the road.

So, what's the confusion? Many applicants have mistaken this standard as addressing or including "delegation". It does not. Delegated entities are organizations that "perform services for your organization". In other words, "which organizations are working for your organization"? Delegation is addressed in significant detail in Standards Core 15- Core 18. So please, do not address delegated entities in your responses to Core 14.