FAQ Directory

NCQA CVO Certification is designed to ensure organizations can maintain a high-quality network for members and contracted clients. The standards provide a framework for adopting industry best practices to promote accurate and efficient verification of practitioner credentials—ensuring that medical organizations employ qualified professionals and align with state requirements.

CVO

NCQA CVO Certification evaluates the operations of organizations that verify practitioner credentials. Verification is accomplished through the primary source, through a recognized source or through a contracted agent of the primary source.

CVO 2016

NCQA LTSS Distinction for Case Management Organizations is a complementary program designed to support organizations that provide comprehensive clinical case management services and coordinate social services for LTSS populations. The program standards provide a framework for organizations to deliver efficient, effective person-centered care that meets people’s needs, helps keep people in their preferred setting and aligns with state requirements.

CM 2017

• Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based, best practices help plans improve in areas of:
  • QI process.
  • Population health management.
  • Practitioner network and access to care.
  • Utilization management processes.
  • Credentialing and recredentialing processes.
  • Members’ rights and responsibilities.
  • Member connection.
  • Medicaid service requirements.
• Satisfy state requirements and employer needs. The standards align with many state requirements.

HP 2020

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

CM 2017

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

CM 2017

CVO Certification assesses an organization’s performance in the following requirement areas:

• Internal Quality Improvement Process
• Protecting Credentialing Information
• Verifying credentials.

NCQA’s CVO Certification program offers the following 11 certification options:

CVO 2016

Any organization that provides wellness and health promotion services can apply for accreditation/certification if it:

• Provides wellness services, either directly or through a service agreement, and
• Provides wellness services for at least three months before survey submission, and 
• Has a process for monitoring, evaluating and improving the quality and safety of services provided to eligible participants.

WHP 2013

Find the Standards and Guidelines document in the NCQA eStore.

HP 2020

• Managed Behavioral Healthcare Organization Accreditation:
  • Provides a framework for internal quality improvement in:
  • Quality Management and Improvement.
  • Care Coordination.
  • Utilization Management.
  • Credentialing and Recredentialing.
  • Members’ Rights and Responsibilities.
• Elevates your organization’s status in the marketplace.
• Improves contracting opportunities.
• Satisfies health plan requirements.

MBHO 2019

Over 1,000 health plan products have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

HP 2020

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

UM-CR 2019