The Status of the New URAC 4.0 Core Standards

I want to remind you to stay aware of changes related to the new CORE 4.0 standards. 

A recent communication from URAC advised that they were going to suspend additional rollout of CORE v.4.0 to programs other than Case Management.  URAC will use Case Management as a test group to determine the impact of Core v.4.0 before proceeding with the roll-out.

Effective August 1, 2018, a modification to the delegation components of existing CORE v.30 standards will be included in all programs that are sold with a CORE component. 

On August 23, 2018, URAC will hold a free webinar for their clients discussing the changes to the Delegation Standards. The link to register is at:

If you are currently accredited your organization should have received a copy of the URAC CORE v3.2 and PHARM CORE v.3.2 Supplement Program Guide with a cross walk between the old Delegation Standards and the new ones.  Previously there were four standards related to Delegation and under version 3.2 there is only one standard. However, Core 9/PHARM Core 9:  Delegation Management element a. states that if your organization delegates functions within the scope of the standards you will retain accountability to URAC for the contracted functions.  So there is relief from the contract wording, but your organization will still have to ensure the delegate carries out their responsibilities in accordance with URAC standards.  There are still some requirements for the contract or formal written agreement, but these are items that would normally be seen in a Scope of Work (SOW).

Element b. of the new Delegation Management Standards requires that you have a process for periodic oversight of the quality of performance and ongoing compliance with pertinent URAC standard.  You will need to specifically name the individual in your organization responsible for the oversight of each Delegate.  For URAC accredited Delegated Vendors validation of their accreditation will meet the requirement.  Non-accredited delegated vendors will need to have a documented over-sight process, a decision on how frequently this will be conducted and reported, identification of the person responsible for the oversight and adoption of a compliance rating scale.

Definitely plan on revising your current delegation policies, procedures and/or plans.  However, many elements in your current documents can be brought across to the new policies and processes.   The more difficult part of the revision may be coordinating the functional requirements and reporting in the contract/agreements with the oversight process and rating scale.  Be glad you know PSN.  We can help you put this in place in a very workable fashion for your organization.  

About the Author:

Carolyn Gray has 30+ years of healthcare management, quality management, credentialing and consulting experience encompassing work with health plans, IROs, short and long term acute care hospitals, rehabilitation facilities, and accreditation surveys.  She has assisted clients, including start up health plans and hospitals, with 55 applications and surveys for URAC, Joint Commission, HFAP, CARF, Medicare, NCQA, and various state surveys; all of which successfully achieved accreditation. Carolyn’s ability to simplify the interpretation of regulations and standards for client staff is one of her strong skills.

About Professional Services Network, Inc. 

Professional Services Network, Inc. (PSN) works with clients nationwide in the search and recruitment of experienced healthcare professionals in managed care and clinical roles for temporary assignments and direct hire opportunities.  Additionally, PSN’s consultants work with organizations and providers seeking accreditation or re-accreditation with URAC or NCQA. For additional information regarding our services contact us at 301-460-4089 or email us at [email protected].