Accreditation for Plans Participating in Health Insurance Marketplaces

HPA 2013 streamlines the accreditation process by reducing administrative burdens for new and currently accredited health plans. Revised standards and point allocations create three accreditation evaluation options and comprise a “glide path”—flexible opportunities for reaching accreditation, regardless of a plan’s longevity or experience with quality reporting.

  • Interim Survey is for plans that need accreditation before or right after they open for business. It focuses on policies and procedures, does not include HEDIS/CAHPS reporting and is valid for 18 months – half as long as the other options.
  • First Survey is for plans new to NCQA, and leads to accreditation that is valid for 3 years. HEDIS/CAHPS reporting is required only in year 3 of accreditation. This helps prepare health plans for Renewal requirements.
  • Renewal Survey is available to NCQA-Accredited plans seeking to extend their accreditation another 3 years. HEDIS/CAHPS reporting is mandatory and plans are scored based on their performance results

Which Scenario is Right for Me?

NEW: NCQA Customer Resources

NEW: Measuring Quality in the Early Years of Health Insurance Marketplaces

NEW: Quality Reporting to Marketplaces

Request an Application

Applications include pricing.

2014 Health Plan and MA Application

Program Support

Policy Clarification Support System
Submit questions related to NCQA standards (policies and procedures).

Resources

Health Plan Accreditation FAQs
Plans new to NCQA - frequently asked questions for plans seeking NCQA Accreditation.