FAQ Directory

The typical evaluation timeframe, from application submission to decision, is 12 months. This depends on the organization’s readiness, as some organizations may already be working within NCQA guidelines.

WHP 2013

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

The Standards and Guidelines document can be found in the NCQA eStore.

WHP 2016

The Accreditation/Certification assesses an organization’s performance in the following requirement areas:

• Workplace program implementation.
• Protection of private health information.
• Ability of services to empower participants to improve their health.

WHP 2013

WHP 2013

NCQA Wellness and Health Promotion Accreditation/Certification evaluates full and limited scope wellness program performance against the standards. Programs should appropriately address implementing a workplace program, protecting private health information and empowering participants to improve their health.

WHP 2013

In general, any organization that operates a physician measurement program or hospital transparency program is eligible for certification. This includes, but is not limited to:

• Health plans.
• Provider networks.
• Collaborative measurement organizations.
• Information providers.

Organizations that meet these criteria are also eligible:

• Operate a physician measurement program or hospital transparency program, as defined in the standards.
• Are responsible for responding to complaints from consumers and to requests for change from physicians or hospitals based on the organization’s actions.
• Comply with applicable federal, state and local laws and regulations, including requirements for licensure.
• Operate without discrimination based on sex, race, creed or national origin.

Note: There are other eligibility criteria. Refer to the standards and guidelines document available in the NCQA eStore.

PHQ

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

UM-CR-PN 2019

The standards and guidelines document is the publication that contains the requirements for certification. You can download this document for free through the NCQA eStore.

These standards include:

For Physician Quality:

• Measures and Methods: Evaluates how an organization measures the quality and affordability of care provided by physicians, including:
  • Use of standard sources.
  • How cost is measured.
  • Defined methodologies.
  • Adherence to key principles.
  • Frequency of measurement.
• Working with Physicians: Evaluates the transparency of the physician measurement program and how organizations work with physicians to respond to requests for corrections or changes.
• Working with Customers: Looks at the organization’s level of transparency with customers (consumers and purchasers) regarding the details of its physician measurement program, and whether the organization works with consumers to address complaints.
• Program Input and Improvement: Ensures that the organization seeks input and feedback on the design of its physician measurement program and on its reporting process, to improve the program’s value to physicians and customers.

For Hospital Quality:

• Hospital Performance: The organization provides consumers and purchasers with information about how hospitals perform, to help them make decisions based on quality and cost. Organizations are evaluated on:
  • Hospital performance data: How they report payer quality and cost information to customers.
  • Decision support tools: Whether hospital reports support informed decision making.
  • Availability of information to customers: Whether they make hospital performance information available to consumers, purchasers and others.
  • Scope of hospitals: How they report performance information on hospitals in the network.
  • Working with hospitals on reporting: Whether they work with network hospitals on reporting.
  • Information about measurement: Whether they make information available about performance-based payments.
  • Feedback on Customer Reports: Whether they seeks customer feedback, with the goal of improving the usefulness of hospital performance reports.

PHQ

Find the Standards and Guidelines document in the NCQA eStore.

UM-CR-PN 2019

Health plans increasingly use physician quality information for value-based contracting, pay-for-performance programs, provider networks, physician tiering and more. Because payers make decisions based on these data, how data are measured is important.

The NCQA Certification process helps ensure that health plans and provider networks make decisions based on sound methodology, and assures patients and physicians that those decisions are transparent and that quality is not sacrificed to cost.

PHQ

UM-CR-PN 2019