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 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 with this status may not have had their HEDIS/CAHPS results evaluated. If HEDIS/CAHPS results were evaluated, organizations must take further action to achieve higher accreditation status. 
 
Provisional: NCQA awards a status of Provisional to organizations with programs for service and clinical quality that meet some, but not all, basic requirements for consumer protection and quality improvement. Organizations awarded this status need to improve their processes as well as clinical and service quality to achieve a higher accreditation status.

Interim: NCQA awards a status of Interim to organizations with basic structure and processes in place to meet expectations for consumer protection and quality improvement. Organizations awarded this status will need to undergo a new review within 18 months to demonstrate they have executed those processes effectively.
 
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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Frequently Asked Questions (FAQs)
FAQs about Accreditation, Certification and HEDIS. Updated the 15th of every month.

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