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DM Accreditation and Certification Levels

What Accreditation Levels Can a DM Organization Achieve?

DM organizations can earn the following NCQA Accreditation status levels based on their performance against NCQA's Standards and Guidelines:

Accredited with Performance Reporting: NCQA awards the status of Accredited With Performance Reporting to organizations that meet or exceed its standards for DM accreditation and report results for a specified number of DM Performance Measures.

Accredited: NCQA awards its highest status of Accreditation to organizations that meet or exceed NCQA standards.                                              

Provisional Accreditation: NCQA awards a status of Provisional Accreditation to organizations that meet some, but not all, of NCQA's basic accreditation standards but must take significant action to achieve Full Accreditation (within 12 months).

Denied: NCQA denies Accreditation to organizations that did not meet NCQA requirements during the Accreditation survey.
 

What Certification Levels Can a DM Organization Achieve?

DM organizations can earn the following NCQA Certification status levels based on their performance against NCQA's Standards and Guidelines.

Certified: NCQA awards a status of Certified to organizations that meet or exceed its standards for DM certification.

Denied: NCQA denies Accreditation to organizations that did not meet NCQA requirements during the Certification survey.

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DM Report Card


View the Disease Management Accreditation and Certification Report Card.

 

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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.