Clinical Services Agreement

The Chief Administrative Officer of the requesting clinical department is responsible for completing the CSA form in part and sending it to the UCLA Managed Care Contracting Office Contract Manager to begin the CSA verification process. Please note that, in certain circumstances, prior authorization from the Clinical Department Head, Department Head and/or Chair of the Faculty Practice Group may be required. Any activity in which a faculty or staff member provides clinical or medical director services outside of UCLA Health requires a Clinical Services Agreement (“CSA”). A CSA may also be used when a non-UCLA physician or provider is responsible for providing clinical services at UCLA, if it has been found that an employment contract would not be appropriate or enforceable. Dr. Eve Glazier (President of the UCLA Faculty Practice Group) has been delegated the authority to conduct CSAS on behalf of UCLA Health. UCLA Health has implemented a CSA development and verification process that requires the completion and submission of a clinical service form (“CSA Form”). A password is required for this form. Please enter “csa11” upon request. The UCLA Managed Care Contracting Office coordinates, where appropriate, the CSA Form process with the UCLA Health Office of Legal Affairs and other administrative departments such as the UCLA Health Office of Risk Management and the UCLA Health Office of Compliance Services. .

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