Customer Service (Core 2.1)

These standards address relations with consumers.

Here's how URAC defines "consumer":

Consumer: An individual person who is the direct or indirect recipient of the services of the Organization.  Depending on the context, consumers may be identified by different names, such as “member,” enrollee,” “beneficiary,” “patient,” “injured worker,” “claimant,” etc. A consumer relationship may exist even in cases where there is not a direct relationship between the consumer and the Organization. For example, if an individual is a member of a health plan that relies on the services of a utilization management organization, then the individual is a consumer of the utilization management organization. 

Interpretive Note for term “Consumer”: In the case of a consumer who is unable to participate in the decision-making process, a family member or other individual legally authorized to make health care decisions on the consumer behalf may be a consumer for the purposes of these standards.