Provider Network Accreditation Evaluation Options 

NCQA’s Provider Network Accreditation requirements are a combination of its credentialing and network management standards. 

 Key Assessment Areas (corresponding standards) 

 

Credentialing Focus Provider Network Focus
Improving operations through an internal QI process (CRA 1) Maintaining sufficient numbers and types of health care practitioners (NET 1)
Ensuring appropriate agreements and collaboration with clients (CRA 2) Establishing mechanisms to provide and maintain appropriate access to healthcare services (NET 2)
Protecting credentialing information (CRA 3) Monitoring access to healthcare services (NET 3)
Ensuring a peer-review process for making credentialing decisions (CR 2) Providing information to members about Marketplace plans; and monitoring member experience (NET 4)
Verifying credentials at initial credentialing and at recredentialing (CR 3, CR 4) Monitoring and taking action to improve network continuity and coordination of care. (NET 5)
Ongoing monitoring of sanctions and complaints (CR 5) Providing information to help members choose a physician or hospital (NET 6)
Assessment of organizational providers (CR 7)  

 

Standards

 

Credentialing Focus  Provider Network Focus
Internal Quality Improvement Process (CRA 1) Availability of Practitioners (NET 1)
Agreement and Collaboration With Clients (CRA 2) Accessibility of Services (NET 2)
Protecting Credentialing Information (CRA 3) Assessment of Network Adequacy (NET 3)
Credentialing Policies (CR 1) Marketplace Network Transparency (NET 4)
Credentialing Committee (CR 2) Continued Access to Care (NET 5)
Credentialing Verification (CR 3) Physician and Hospital Directories (NET 6)
Recredentialing Cycle Length (CR 4) Delegation of Provider Network (NET 7)
Ongoing Monitoring (CR 5)  
Notification to Authorities and Practitioner Appeal Rights (CR 6)  
Assessment of Organizational Providers (CR 7)  
Delegation of Credentialing (CR 8)  

 

New Online Application Process

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


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NCQA Policy Support

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