Clinical Services Agreement

The administrative manager of the soliciting clinical division is responsible for filling out and sending the CSA form to the UCLA Managed Care Contracting Office contract manager to initiate the CSA verification process. Please note that, in certain circumstances, prior approval may be required from the Chair of the Clinical Department, the Head of Department and/or the Chair of the Faculty Practice Group. Any activity in which a teacher or staff member provides clinical or medical management services outside of UCLA Health requires a clinical services agreement (“CSA”). A CSA may also be used when a physician or non-UCLA provider is responsible for providing clinical services to UCLA, when it has been found that a work agreement was not appropriate or that it applied. Dr. Eve Glazier (Chair of the UCLA Faculty Practice Group) was empowered to perform CSAs on behalf of UCLA Health. UCLA Health has a CSA development and verification process that requires the filling and submission of a clinical services form (“CSA form”). A password is required for this form. Please enter “csa11” upon request. The UCLA Managed Care Contracting Office will coordinate the CSA form process with the UCLA Health Office of Legal Affairs and other administrative offices such as the UCLA Health Office of Risk Management and the UCLA Health Office of Compliance Services.