MCO_Excellent_RGB_lowres.jpgNCQA MCO Accreditation is designed to let employers and consumers distinguish between health plans based on quality.  Accreditation evaluates not only the core systems and process that make up a health plan, but the actual results that the plan achieves on key dimensions of care and service, as well.

The review process is rigorous, consisting of on-site and off-site evaluations conducted by teams of physicians and managed care experts. The ROC, a national oversight committee of physicians analyzes thesurvey teams' findings and assigns an accreditation level based on a plan's compliance with NCQA's standards and its performance relative to other plans on selected HEDIS performance measures, such as immunization and mammography rates and member satisfaction.

Developed with the input and support of employers, unions, health plans and consumers, NCQA's requirements are demanding. NCQA purposely set the standards high to encourage health plans to continuously enhance quality.

Health Plan Accreditation MCO/PPO

NCQA has discontinued the separate MCO Accreditation Program and PPO Accreditation Program in favor of a single, consolidated set of standards and guidelines. This new, comprehensive program, Health Plan Accreditation, applies to HMO, POS and PPO health plans. To learn more about this new program, visit the Health Plan Accreditation Web page.

Other MCO Related Programs

Market Your Quality

Health Plan Report Card

How does your Health Plan rate?

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.