The Basics

This standard, the first of several standards dealing with contractual arrangements with participating providers, offers the simple requirement that you have written agreements with all of your participating providers.  Naturally, if your organization is contracting with the provider group, you may have a single contract with the entire group rather than each individual participating provider.  However, the underlying point of this contract remains the same: there must be a contractual relationship, embodied in a written agreement, between your organization and every provider in your network.

Management Tips

Although the interpretive materials that accompany this standard don't suggest that this is required, we do recommend that you incorporate the sentiment of this standard into a policy and procedure.  In other words, your policies and procedures should make it clear that every provider must have a corresponding contract.

URAC Accreditation Tips

This is a mandatory standard.

For the desktop review, we recommend that you submit the policy and procedure that incorporates this requirement of a written agreement for every provider.  In addition, that policy and procedure should describe the contracting process and the minimum requirements of those contracts, as spelled out in the next several standards.  In addition, we recommend that you submit a template agreement, one for each category of provider in your network (e.g., primary care provider, specialist, hospital, ancillary provider).  In addition, submit a list of any significant revisions in your provider contracts over the last two years, along with the date and description of each such revision.  Finally, because your provider manual likely will be an important part of the documentation for the next several standards, we recommend that you submit it here.

During the on-site review for this and all the standards in this training section, the reviewer will use your provider manual to select at least 30 participating providers and asked to see the contracts for each.  Make sure that, when you deliver the contracts to the on-site reviewer, it is clear to which of the selected providers each contract applies.  For example, if the name of the provider that the reviewer selects is not on the face sheet of the contract (perhaps because the provider is a member of the group with which the contract is executed) a fix a Post-it note to the contract that bears the name of the provider that the reviewers selected from the provider directory