MCO Accreditation


NCQA 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

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Market Your Quality

Health Plan Report Card

How does your Health Plan rate?

HEDIS Users Group (HUG)
HUG membership packages offer you access to the most up-to-date information on HEDIS specifications so you can begin planning for the future.

HEDIS and ICD-10
To accommodate the switch from ICD-9-CM to ICD-10, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure.


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