FAQ Directory

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:

• 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:

More than 90 organizations have earned CVO Certification. A directory of Certified organizations can be found at the NCQA Report Card.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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:

Organizations that have earned NCQA LTSS Distinction can be found in the NCQA Report Card.

This applies to the following Programs and Years:

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:

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:

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

This applies to the following Programs and Years:

An organization is eligible for the NCQA LTSS Distinction if:

• It has a current NCQA Accreditation status, or
• Is seeking NCQA Case Management Accreditation.

Note:  NCQA conducts LTSS Distinction Surveys at the legal-entity level.
 

This applies to the following Programs and Years:

Note: A “practitioner network” is the practitioner network of clients and organizations.

This applies to the following Programs and Years: