Core 3.2

CORE 11 - Written Business Agreements

Submited by: Tom Goddard

The Basics

My colleagues and I have noticed, as have some veteran URAC reviewers to whom we've spoken lately, that some folks are still misinterpreting this standard. Let me see what we can do to help sort out the confusion.
The standard requires that your organization keep "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 this standard.1 The key to understanding this is to focus on what a "client" is. In "URAC-Land", 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 6-9. So please, do not address delegated entities in your responses to this standard.

Management Tips

About the only way you can get in trouble for this standard is if you allow your contracts with clients to expire. Therefore, we recommend that you establish a system which tracks client contract expiration dates and guides your company on mechanisms for the review and renewal of those contracts.
We also recommend using templates for your client agreements, as well as a P&P to cover client contracting.

Accreditation Tips

Desktop Review
This is a simple standard to document -- for the desktop review, submit a template business agreement. If you don't have a template, submit 2-3 sample business agreements. You may excise compensation provisions and other areas that you consider trade secrets.
Some reviewers have begun to go beyond the Accreditation Guide and require that you submit "a policy that states the organization maintains written agreements with all clients. So, to be safe, we recommend that you submit such a policy, even though it is not required by the Accreditation Guide.
Validation Review
For the onsite review, submit three typical business agreements. Just make sure that, in both cases, the agreements describe the scope of the services you are providing.