Certification in UM/CR

NCQA’s Certification in UM/CR program is available to a variety of organizations that perform Credentialing (CR) and/or Utilization Management (UM).  The standards represent a merger of the POC (Physician Organization Certification) and OC (Organization Certification) products into a single set of standards designed for organizations that provide full scope CR or UM services or both. NCQA Certification provides these organizations the opportunity to demonstrate the quality of their UM and CR programs.

NCQA‘s certification review includes a rigorous on- and off-site evaluation conducted by a team of physicians and managed care experts. A review oversight committee of physicians analyzes the team's findings and assigns a certification status based on the organization’s performance against standards within applicable certification options. 

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UM/CR Report Card

View the Utilization Management/Credentialing Certification Report Card.

NCQA Policy Support

Frequently Asked Questions (FAQs)
FAQs about Accreditation, Certification and HEDIS. Updated the 15th of every month.

Policy Updates & Supporting Documents
News about Accreditation, Certification and HEDIS measures.

Policy Clarification Support (PCS)
Can't find what you need in FAQs or Policy Updates? Submit your question here.