Menu

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
  • Email
  • Print
expand all

8.24.2018 Where can I find the Provider Network Standards and Guidelines?

8.24.2018 How does Physician and Hospital Quality Certification help our organization?

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

8.24.2018 How does Provider Network Accreditation help my organization?

Use the NCQA Provider Network Accreditation standards to perform a gap analysis and determine improvement areas. The standards provide a framework for implementing industry best practices to:

  • Improve operational efficiencies.
    • Consistent monitoring of practitioner availability and accessibility of services.
    • Efficient collection and analysis of member-experience data.
    • Appropriate credentialing of practitioners and providers.
  • Elevate your organization’s reputation. Accreditation demonstrates that your organization has the processes and procedures to provide effective network management services.
  • Align with state requirements. Use accreditation standards to improve your internal operations and align with state requirements.
  • Improve contracting opportunities. Ability to reduce administrative responsibility for NCQA-Accredited organizations that delegate network management and credentialing activities.
 

UM-CR-PN 2019

8.24.2018 What is Physician and Hospital Quality Certification?

NCQA’s Physician and Hospital Quality Certification program evaluates how well organizations measure and report the quality and cost of physicians and hospitals. NCQA looks at measurement processes and methodology, transparency, collaboration and the balance between quality/cost when using the information to make decisions.

PHQ

8.24.2018 What is the price for the LTSS Distinction for Case Management Organizations?

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

CM 2017

8.24.2018 Where can I find the Physician and Hospital Quality Standards and Guidelines?

8.24.2018 How does the Medicaid Module help my organization?

Meeting NCQA Medicaid Module standards can help organizations:

  • Streamline compliance activities. Compliance activities are reduced when the state uses NCQA Health Plan Accreditation and Medicaid Module standards as part of the Medicaid quality review.
  • Become more efficient. Reallocate key quality review resources to other Medicaid priorities.

HP 2020

8.24.2018 What other organizations have earned Utilization Management Accreditation?

More than 50 organizations have earned NCQA Utilization Management Accreditation. See the NCQA Report Card for a directory of accredited organizations.

UM-CR

8.24.2018 How long does it take to earn LTSS Distinction for Health Plans?

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.

HP 2020

8.24.2018 What other organizations have earned Provider Network Accreditation?

Several organizations have earned NCQA Provider Network Accreditation. See the NCQA Report Card for a directory of accredited organizations.

UM-CR-PN 2019

8.24.2018 Where can I find the LTSS Distinction Standards and Guidelines?

8.24.2018 How long does it take to earn Provider Network Accreditation?

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.

UM-CR-PN 2019