2018 Credentialing Accreditation
The new CR Accreditation program is effective on July 1, 2018.
The NCQA CR Accreditation program is available to a variety of organizations that perform CR activities. The standards, designed for organizations that provide full scope CR services, provide a framework for implementation of industry best practices to ensure:
- Efficient and accurate credentialing and recredentialing
- Verification of practitioner credentials through the primary source, a recognized source or a contracted agent of the primary source
- A designated credentialing committee reviews practitioner credentials and makes credentialing recommendations
- Alignment with state requirements
NCQA Accreditation demonstrates the quality of CR organization programs to employers, regulatory agencies, health plans and MBHOs.
The Accreditation Survey includes a rigorous evaluation conducted by a team of physicians and managed care experts. An independent review oversight committee of physicians analyzes the team’s findings and assigns an accreditation status based on the organization’s performance against standards.
To be eligible for CR Accreditation, organizations:
- Must not be licensed as an HMO, POS, PPO or EPO
- Must not be eligible for NCQA Accreditation as a health plan or an MBHO
- Must perform CR functions directly or through contractual agreement
- Must perform CR activities for at least 50% of the practitioner network
Note: “Practitioner network” refers to the practitioner network of clients and organizations
Accreditation Statuses an Organization Can Achieve
Organizations can earn the following NCQA Accreditation status levels based on their performance against NCQA’s Standards and Guidelines.
- Accredited - 3 years: NCQA awards a status of Accredited – 3 years to organizations that demonstrate strong performance of the functions outlined in the CR standards.
- Accredited - 2 years: NCQA awards a status of Accredited – 2 years to organizations that demonstrate performance of the functions outlined in the CR standards.
- Denied: NCQA awards a status of Denied Accreditation to organizations that do not meet NCQA requirements.
In-Depth Program Information