Application submission fee is $10,000. Organizations should use the Invoice and Payment Information Form included in the application packet to generate their own invoice for the application fee.
FAQ Directory
Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
Filter Results
- Save
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
- Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
- Print
Print this page.
Print this page.
9.15.2012 Pricing What is due at the time of the application submission?
9.15.2012 Timing What is the duration of the Exchanges Add-on Survey accreditation status?
The Exchanges Add-on Survey accreditation status is valid until your existing accredited products accreditation status expires.
For example:
You have Commercial HMO accreditation, which expires in January 2015.
You bring in your Exchange HMO for accreditation now, through the Exchanges Add-on Survey.
Your accreditation status for the Exchange product line is valid until your Commercial HMO expires in January 2015.
9.15.2012 Basics How is the Exchange Add-on Survey different from the regular Add-on Survey?
The Exchange Add-on Survey is a streamlined version of the regular Add-on Survey:
Plans do not submit HEDIS/CAHPS
Since HEDIS/CAHPS are not submitted, plans are capped at Accredited status.
NCQA reviews documentation of standards only when the organization manages functions differently from key elements. (The Application defines which standards are required and how many functions are permitted to be performed differently).
No file review for the Exchange product line.
9.15.2012 Basics What is evaluated in the Exchange Add-on Survey?
The Exchange Add-on Survey evaluates plans on a subset of standards and elements listed in Section 7 of the NCQA HPA Exchange Add-on Survey Application. For an organization that will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines, NCQA will award Accreditation to the Exchange product line without conducting a formal survey. An organization qualifies for automatic Accreditation if it attests that it will administer 70% or more of the elements listed in Section 7 in the same manner.
9.15.2012 "In-print" format Is including a "print" option in an online document enough to meet NCQA's "in print" requirement?
9.15.2012 Timing How long does it take to receive an accreditation status?
Once you submit your application, NCQA will determine if your organization is eligible for automatic accreditation. If you apply before February 1, 2013 and NCQA determines your organization is eligible for automatic accreditation then NCQA will award the accreditation status in the first quarter of 2013. If you apply after February 1, 2013 and NCQA determines your organization is not eligible for automatic accreditation then NCQA will award the accreditation status about two months after you apply.
If upon review of your application, NCQA determines that your organization is eligible for automatic accreditation, NCQA staff will contact you to schedule a date to start your Exchange Add-on survey and issue an ISS tool to you to complete and submit on the start date. If your organization achieves accreditation then the status will be awarded about three months after the start of the survey.
Note that NCQA posts accreditation status updates on its Web site once a month on the 15th of each month for statuses effective as of the end of the previous month.
9.15.2012 Contact Information Who can I contact if I would like to learn if the Exchange Add-on Survey is the correct path for my plan?
8.16.2012 Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis What combination of visits with a diagnosis of rheumatoid arthritis may be used to meet the event/diagnosis criteria?
Although the event/diagnosis criteria do not specifically state "and/or," it is implied. As long as there are two outpatient visits or two nonacute inpatient discharges, or one outpatient visit and one nonacute inpatient discharge, with a diagnosis of RA, the member meets the criteria for eligible population.
HEDIS 2013
8.16.2012 Comprehensive Diabetes Care May documentation of the glomerular filtration rate (GFR) test be used when reporting the Medical Attention for Nephropathy indicator?
No. GFR testing is not currently acceptable for the Medical Attention for Nephropathy indicator. Clinical experts determined that certain characteristics, such as age, sex and race, may impact the effectiveness of such tests for monitoring nephropathy. If a member was determined to have impaired kidney function based on a GFR test, it is expected that there would be other documentation in the medical record that would make the member compliant for the nephropathy indicator (e.g., documentation of a visit to a nephrologist or documentation of medical attention for any appropriate conditions listed in the specifications).
HEDIS 2013