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 CVO Certification requirements?

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:

  • License to Practice
  • State Licensing Board Sanctions
  • DEA or CDS Certification
  • Medicare/Medicaid Sanctions
  • Education and Training
  • Practitioner Application Processing
  • Board Certification Status
  • Application and Attestation Content
  • Work History
  • Ongoing Monitoring of Sanctions
  • Malpractice Claims History
  

This applies to the following Programs and Years:
CVO 2016

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.

This applies to the following Programs and Years:
CM 2017

8.24.2018 Where can I find the Health Plan Accreditation Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

8.24.2018 How does Health Plan Accreditation help my organization?

  • 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.

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

8.24.2018 What other organizations have earned Health Plan Accreditation?

Over 1,000 health plan products 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:
HP 2017, 2018, 2019, 2020

8.24.2018 What organizations are eligible Wellness and Health Promotion Accreditation/Certification?

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.

This applies to the following Programs and Years:
WHP 2014, Cert, 2016, Cert|2013 WHP|Cert 2014|2016 WHP

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 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 What is the price for Utilization Management 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:
UM-CR 2017|UM-CR-PN 2018, 2019

8.24.2018 What is the process for earning Utilization Management Accreditation?

The first step to earning accreditation is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the utilization management standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

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

8.24.2018 How long does it take to earn Utilization Management 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.

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

8.24.2018 What organizations are eligible for Utilization Management Accreditation?

Utilization Management Accreditation is for organizations that provide full scope utilization management services. Eligible organizations:

  • Must not be licensed as an HMO, POS, PPO or EPO.
  • Must not be eligible for NCQA Accreditation as a health plan or an MBHO.
  • Must perform utilization management functions directly or through a contract.
  • Must perform utilization management activities for at least 50% of the members.
​Note: “Members” refers to membership of clients and organizations.

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