FAQ Directory

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

This applies to the following Programs and Years:

NCQA Health Plan Accreditation is the most widely recognized, evidence-based program in the industry dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. It’s the only evaluation program that bases results on actual measurement of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures).

This applies to the following Programs and Years:

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:

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

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

More than 40 organizations have earned Credentials Verification Organizations Certification. A directory of Certified organizations can be found at the NCQA Report Card.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

An organization is eligible for the NCQA Health Plan Medicaid Module if:

• Its Medicaid product line has a current NCQA Accreditation status as a First or Renewal Survey, or
• It is seeking accreditation for its Medicaid product line under NCQA HP Accreditation as an Interim, First or Renewal Survey.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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: