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Managed Behavioral Healthcare Organization (MBHO) Accreditation

NCQA Managed Behavioral Healthcare Organization (MBHO) Accreditation demonstrates to health plans, employers, regulators and consumers that an organization follows evidence-based practices for providing high-quality care, access and consumer protections.

MBHO accreditation emphasizes:

  • Care coordination to reduce fragmented care, especially for people with special needs.
  • Complex case management, a challenge for managed care initiatives where complex cases are common.
  • Data exchange between health plans and behavioral healthcare organizations, to support clinical quality and patient experience measurement and improvement by the MBHO.

Behavioral healthcare organizations earn NCQA Accreditation by proving their proficiency across five standards:

  • Quality Management and Improvement  The organization has processes designed to monitor, evaluate and improve the quality and safety of care provided to its members, including those with complex needs.
  • Care Coordination The organization coordinates medical care and behavioral healthcare for its members
  • Utilization Management The organization notifies members and practitioners about coverage decisions within required time frames. 
  • Credentialing and Recredentialing The organization verifies the credentials of the practitioners in its network.
  • Members’ Rights and Responsibilities The organization has a written members’ rights and responsibilities policy.

What Accreditation Levels Can a MBHO Achieve?

MBHOs can earn the following NCQA Accreditation status levels based on their performance against NCQA's Standards and Guidelines.

  • Full Accreditation: NCQA awards its highest accreditation status of Full Accreditation to organizations that meet or exceed NCQA standards and have excellent programs for quality improvement and consumer protection.
  • One-Year Accreditation: NCQA awards a status of One-Year Accreditation to organizations that meet most NCQA standards and have well-established programs for quality improvement and consumer protection. Organizations are given recommendations for improvement and are resurveyed in one year to determine qualification for Full Accreditation.
  • Provisional Accreditation: NCQA awards a status of Provisional Accreditation to organizations that meet some, but not all, of NCQA's basic requirements for consumer protection and quality improvement.
  • Denied Accreditation: NCQA denies Accreditation to organizations that did not meet NCQA’s requirements during the Accreditation Survey.

NCQA issues Accreditation Seals for Full and One-Year Accredited status levels. NCQA does not issue a seal for Provisional Accreditation and Denied Accreditation status levels.

Questions?

For more information, please e-mail pcmh-grip@ncqa.org or call (888) 275-7585, M-F, 8:30 a.m. - 5:00 p.m. ET.

New Online Application Process

A new application and scheduling process begins May 15 for Accreditation programs.


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MBHO Report Card

How does your Managed Behavioral Healthcare Organization 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.

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