The Basics

This standard, new with this version of the PBM standards, requires that your organization promote collaboration and cooperation with external entities for the purpose of coordinating care for your consumers/patients.  There could be a number of ways in which your organization does this.  For example, it might be that your organization works with community resources to provide care, or when you delegate functions to outside organizations.  It might be that your organization shares information with other organizations with the intent of coordinating care.

Management Tips

While it is likely that your organization does one or more things to coordinate care with external entities, it may be that this coordination is not documented.  Management should make sure that some documentation exist, whether it be in a program description, P&Ps, or consumer newsletters.  

URAC Accreditation Tips

This standard, like many new standards, carries a weight of only 1. The diversity of ways of meeting this standard is so large that just about any documentation you have of such activity will suffice for the desktop review.  Examples include program description, P&P, newsletters, and the like. During the onsite review, the reviewer is likely to rely on interviews with key staff members involved in coordinating care with external entities.  The reviewer also may find evidence of such coordination in the examination of case files.