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What Accreditation Status Can Plans Achieve?

Health plans can earn the following NCQA Accreditation status based on their performance against NCQA's rigorous requirements and their performance on HEDIS® and CAHPS® measures.  A plan’s status can be found on the NCQA Health Plan Report Card.

Excellent: NCQA awards its highest status of Excellent to organizations with programs for service and clinical quality that meet or exceed rigorous requirements for consumer protection and quality improvement. HEDIS/CAHPSresults are in the highest range of national performance.
 
Commendable: NCQA awards a status of Commendable to organizations with well-established programs for service and clinical quality that meet rigorous requirements for consumer protection and quality improvement. Organizations with this status may not have had their HEDIS/CAHPS results evaluated. If HEDIS/CAHPS results were evaluated, organizations must take further action to achieve higher accreditation status. 
  
Accredited: NCQA awards a status of Accredited to organizations with programs for service and clinical quality that meet basic requirements for consumer protection and quality improvement. Organizations with this status may not have had their HEDIS/CAHPS results evaluated. If HEDIS/CAHPS results were evaluated, organizations must take further action to achieve higher accreditation status. 
 
Provisional: NCQA awards a status of Provisional to organizations with programs for service and clinical quality that meet some, but not all, basic requirements for consumer protection and quality improvement. Organizations awarded this status need to improve their processes as well as clinical and service quality to achieve a higher accreditation status.

Interim: NCQA awards a status of Interim to organizations with basic structure and processes in place to meet expectations for consumer protection and quality improvement. Organizations awarded this status will need to undergo a Full Survey within 18 months to demonstrate they have executed those processes effectively.
 
Denied: NCQA awards a status of Denied Accreditation to organizations whose programs for service and clinical quality do not meet NCQA requirements.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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Health Plan Report Card

How does your Health Plan rate?

 

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HEDIS Users Group (HUG)
HUG membership packages offer you access to the most up-to-date information on HEDIS specifications so you can begin planning for the future.

HEDIS and ICD-10
To accommodate the switch from ICD-9-CM to ICD-10, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure.

Interactive Review Tool (IRT)
Learn more about the IRT Web-based Survey Platform.