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Reconsidering NCQA Recognition Status

How do I request reconsideration?

I think NCQA may have misinterpreted my documentation.

 Reconsideration 
 Recognition Level 1 or
Level 2 

 Denied  
 Recognized Level 3 
 May I submit a Reconsideration request? 
Yes
Yes 
 Yes, but it will not increase the recognition level. 
How much do I pay?
 
$1,100 per site or the Add-On Survey fee, whichever is less.
Pricing and Fee Schedule  

$1,100 per site or the Add-On Survey fee, whichever is less.
Pricing and Fee Schedule  

$1,100 per site or the Add-On Survey fee, whichever is less.
Pricing and Fee Schedule  
When may I submit?  No later than 30 days after the recognition decision.  No later than 30 days after the recognition decision.  No later than 30 days after the recognition decision. 
May I submit NEW documentation to meet the requirements?  No; only a statement of how NCQA misinterpreted the original documentation.  No; only a statement of how NCQA misinterpreted the original documentation.  No; only a statement of how NCQA misinterpreted the original documentation. 

Reconsideration Process

Step 1: Submit Reconsideration Request and Payment to NCQA

  • Fill out the reconsideration request form and submit to rpreconrequest@ncqa.org  within 30 days of the recognition decision, outlining the disputed elements and factors.
  • Remit payment of $1,100 or the cost of an Add-On Survey, whichever is less, for each site submitting for Reconsideration. 
– By mail:

NCQA Recognition Programs
Attn: PCMH Reconsideration
Department 4038
Washington, DC 20042-4038

Step 2: NCQA and ROC Review Request

  • The Assistant Director of Recognition Programs handles the Reconsideration request.
  • A group of NCQA staff who were not a part of the original decision review the elements and factors submitted. 
  • NCQA staff make a recommendation to a group of three ROC members who were not a part of the original decision.
  • NCQA staff and ROC members review the documentation and information in the Web-based Survey Tool. 
  • The ROC members make a Reconsideration decision.
  • The ROC’s decision is final and there is no further right to appeal.
Step 3: NCQA Notifies Practice of Decision

  • NCQA sends a notification e-mail of the Reconsideration decision, with comments.
  • NCQA updates your practice’s survey to reflect changes in scoring or level, if applicable.
  • If the Reconsideration results in a higher recognition level, your practice is issued a new certificate and the NCQA Web site and data feeds are updated.