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.

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8.24.2018 What are the Utilization Management Accreditation requirements?

Utilization Management Accreditation assesses an organization’s performance in the following areas:

  • Improving operations through an internal QI process
  • Ensuring appropriate agreements and collaboration with clients
  • Maintaining member confidentiality
  • Ensuring involvement of appropriate professionals
  • Making fair and timely decisions
  • Handling member appeals in a fair and timely manner
  • Measuring member and provider experience

 
To see all program requirements, get the Standards & Guidelines document.
 

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 2019

8.24.2018 Where can I find the MBHO Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:
MBHO 2017, 2018, 2019

8.24.2018 How does MBHO Accreditation help my organization?

  • 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.

This applies to the following Programs and Years:
MBHO 2017, 2018, 2019

8.24.2018 What other organizations have earned Managed Behavioral Healthcare Accreditation?

More than 30 organizations have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

This applies to the following Programs and Years:
MBHO 2017, 2018, 2019

8.24.2018 What is the price for Managed Behavioral Healthcare Accreditation?

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

This applies to the following Programs and Years:
MBHO 2017, 2018, 2019

8.24.2018 How long will it take to earn CVO Certification?

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.

This applies to the following Programs and Years:

8.24.2018 What is Managed Behavioral Healthcare Organization Accreditation?

NCQA Managed Behavioral Healthcare Organization Accreditation is a comprehensive, evidence-based evaluation that reviews organizations to assure they use processes to deliver high-quality care and access. It provides a framework for organizations to align and improve operations in areas of quality improvement, care coordination, utilization management and credentialing and recredentialing and members’ rights.

This applies to the following Programs and Years:
MBHO 2017, 2018, 2019

8.24.2018 What organizations are eligible for CVO Certification?

Any organization that provides credentials verification services can apply for Certification if it:

  • Verifies practitioner credentials for health plans, MBHOs, physician organizations or health care organizations, and
  • Provides verification services for at least six months before application, and 
  • Performs verification activities for at least 50% of contracted practitioners, and
  • Maintains the necessary credentials documentation, policies and procedures for NCQA to conduct the survey, and
  • Obtains errors and omissions insurance for $1M–$2M.

This applies to the following Programs and Years:

8.24.2018 What is the price for CVO Certification?

Pricing is based on multiple factors. Full pricing information can be obtained by submitting a request through My NCQA.

This applies to the following Programs and Years:

8.24.2018 Where can I find the CVO Standards and Guidelines?

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

This applies to the following Programs and Years:

8.24.2018 How does CVO Certification help my organization?

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.

This applies to the following Programs and Years:

8.24.2018 What is CVO Certification?

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.

This applies to the following Programs and Years:
CVO 2016