New Health Plan Status List

The New Health Plan (NHP) Accreditation Status List, updated on the 15th of each month, catalogs all NHPs that have an accreditation status with NCQA, all NHPs with pending accreditation decisions and all NHPs scheduled to be surveyed. NHP accreditation is available to health plans that have been in existence less than three years and is awarded for a three year period.   It evaluates how well a plan manages its clinical and administrative systems to deliver value to purchasers and improve health care for its members.  An organization that achieves NHP accreditation is scheduled for a Health Plan Accreditation (HPA) survey for its subsequent review. NCQA’s HPA standards evaluate an organization’s core systems and process, as well as performance results that the plan achieves on key dimensions of care, service and efficiency.

New Health Plan Accreditation
 Plan NamePlan Office LocationExpiration DateNext Review DateAccreditation Status
Aetna Better Health, Inc., a Pennsylvania corporationPhiladelphia, PA12/23/2014 10/15/2014Accredited
Amerigroup Louisiana, Inc.Metairie, LA09/11/201606/28/2016Accredited
AMERIGROUP Nevada, Inc. Las Vegas, NV 12/06/201409/17/2014 Accredited
BlueChoice Health Plan of South CarolinaColumbia, SC08/08/201405/21/2014Accredited
Carilion Clinic Medicare Resources, LLC
d/b/a MajestaCare Healthplan 
Roanoke, VA 09/23/201606/28/2016Accredited
CeltiCare Health Plan of Massachusetts,Inc. Brighton, MA08/29/201506/02/2015Accredited
UnitedHealthcare Community Plan, Inc - New Mexico Albuquerque, NM08/03/201405/20/2014Accredited
UnitedHealthcare Insurance Company
dba UnitedHealthcare Community Plan (HI QExA and QUEST)
Honolulu, HI4/11/201501/20/2015Accredited
UnitedHealthcare Insurance Company dba UnitedHealthcare Community Plan (MS CHIP)Ridgeland, MS02/20/201611/17/2015Accredited
UnitedHealthcare of Mississippi, Inc dba UnitedHealthcare Community Plan (MS CAN) Ridgeland, MS02/20/201611/17/2015Accredited
WellCare Health Insurance of Arizona, IncWaipahu, HI03/28/201512/17/2014Accredited

What is the NHP Accreditation Status List?
The list is in three parts, each organized alphabetically. Part 1 shows all NHPs that have a current accreditation status; Part 2 shows NHPs with decisions pending; and Part 3 shows NHPs with surveys scheduled within the next 18 months. NHPs that are not on the list have not scheduled an NCQA Accreditation survey.

Part 1: Current Accreditation Status. The levels of accreditation decisions are described briefly below. For a complete description, see the revised NCQA Policies and Procedures.

NHP Accreditation is granted for a period of three years to those NHPs that have in place sound organizational structures and processes to monitor and improve the quality of care and service provided to its members and meet NCQA's rigorous standards for NHPs.

Denial is given to those NHPs that do not qualify for accreditation.

Under Review denotes those NHPs for which an initial accreditation determination has been made but is under review at the request of the NHP.

Expired denotes a NHP that has allowed its accreditation status to lapse without scheduling another accreditation survey. The NHP may undergo only one survey under the NHP standards, any subsequent surveys are under the full Standards for the Accreditation of Managed Care Organization in effect at the time of the survey. NHPs receiving a denial do not revert to "expired."

NCQA Discretionary Review denotes those NHPs which NCQA has chosen to review in order to assess the appropriateness of an existing accreditation decision.

Part 2: Initial Decision Pending lists those NHPs that have been reviewed for the first time but have not yet received a decision.

Part 3: Future Review Scheduled shows the date of all initial reviews scheduled within the next 18 months.

How Should Consumers and Purchasers Use the List?
Accreditation status is not a guarantee of the quality of care that any individual patient will receive or that any individual physician or other provider delivers. However, NHPs that are accredited have demonstrated that they provide the consumer protections required by NCQA standards and that they have in place the structure and foundation to monitor and continuously improve the quality of care they deliver.