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Health Plan Accreditation

More than 116 million Americans (70.5% of all health plan members) are covered by an NCQA-Accredited health plan.

  • 90% of health plans report HEDIS data.
  • 32 states collect or require HEDIS performance data.

NCQA Health Plan Accreditation helps employers and consumers distinguish between health plans based on quality and value. Accreditation uses a unified set of standards for HMOs, MCOs, PPOs and POS plans.

Accreditation evaluates not only the core systems and process that make up a health plan, but also the actual results that the plan achieves on key dimensions of care, service and efficiency. A rigorous survey process involves onsite and offsite evaluations conducted by a survey team of physicians and managed care experts.

The onsite survey is a two-day visit, during which trained NCQA surveyors—including physicians—interview plan staff and review materials that cannot be submitted electronically, such as case records, meeting minutes and other confidential documents.

NCQA’s Review Oversight Committee (ROC), a national panel of physicians, analyzes the survey team’s findings and assigns an accreditation status based on the plan’s compliance with NCQA standards and its performance on selected HEDIS measures, relative to other plans.

Developed with the input and support of health plans, purchasers, unions and consumer groups, NCQA standards are demanding, encouraging continuous enhancement of a plan’s quality and value.