What Accreditation Levels Can a Plan Achieve?

Health plans can earn the following NCQA Accreditation status levels based on their compliance with NCQA's rigorous requirements and their performance on HEDIS® and CAHPS® measures.  A plan’s status can be found on the NCQA Health Plan Report Card.

Excellent: NCQA awards its highest accreditation status of Excellent to organizations with programs for service and clinical quality that meet or exceed rigorous requirements for consumer protection and quality improvement. HEDIS and CAHPS results are in the highest range of national performance.
 
Commendable: NCQA awards a status of Commendable to organizations with well-established programs for service and clinical quality that meet rigorous requirements for consumer protection and quality improvement.

Accredited: NCQA awards an accreditation status of Accredited to organizations with programs for service and clinical quality that meet basic requirements for consumer protection and quality improvement. Organizations awarded this status must take further action to achieve a higher accreditation status.
 
Provisional: NCQA awards a status of Provisional to organizations with programs for service and clinical quality that meet basic requirements for consumer protection and quality improvement. Organizations awarded this status must take significant action to achieve a higher accreditation status.
 
Denied: NCQA denies Accreditation to organizations whose programs for service and clinical quality did not meet NCQA requirements during the Accreditation survey.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

  

 


Health Plan Report Card

How does your Health Plan rate?


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