FAQ Directory

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

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:

NCQA Utilization Management Accreditation is designed to ensure that organizations pursuing accreditation can deliver fair and timely determinations to get the proper care to patients while effectively managing resources. The standards provide a framework for adopting industry best practices to objectively and efficiently evaluate the appropriateness of requested health care services.

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:

NCQA Utilization Management Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope utilization management services, which include using evidence-based criteria, relevant clinical information and qualified health professionals to make utilization management decisions.

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:

NCQA Provider Network Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the accessibility and transparency of organization networks and credentialing of practitioners and providers. NCQA-Accredited organizations demonstrate they have the internal processes and procedures to effectively manage access to care and member experience while ensuring that practitioners and providers are appropriately credentialed.

This applies to the following Programs and Years:

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:

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:

Find the Standards and Guidelines document in the NCQA eStore.

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:

• 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: