Core for Health Plan 3.2

CORE 1 - Organizational Structure

Submited by: Tom Goddard

The Basics

Core 1 requires that your organization clearly defines its structure, roles, and responsibilities. This standard is rather straightforward and seldom the subject of a comment by URAC reviewers. Its purpose is to give the reviewer an understanding of the structure, ownership, and reporting mechanisms of the organization. 

Management Tips

If you submit organization charts and program descriptions, you probably won't get any comments from the URAC reviewer. However, you may be asked for more information beyond this if there is something about the ownership structure that is unclear. For example, if you have a holding company or corporate affiliate, the name of which is all over your company documents but not reflected in the organizational charts, the reviewer may ask for some more detail.

Accreditation Tips

Desktop Review
The applicant should submit organizational charts at both the macro level (with senior organizational leadership described) and at the department level for the departments who are the subject of the accreditation under consideration. Additionally, organizational charts should show key committees, especially the Quality Management Committee and any other accreditation-relevant committees (e.g., credentialing committees for Health Plans and Health Networks). Any official company documents that describe the organization, particular the services that are the subject of the accreditation, will help, too.
Validation Review
Document Review
The reviewer will want to see a current organization chart to track any changes that may have occurred since the desktop submission.
Most of this is covered in the opening conference of the verification review. Interviews throughout the review, too, will confirm the reviewer's understanding of the organization's structure