FAQ Directory

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 Case Management Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based best practices to ensure:

• Efficient and cost-effective case management processes and service delivery.

• Apply a QI process to improve operations.
• Maintain security of personal health information.
• Ensure patient access to well-qualified case management staff.
• Develop personalized, patient-centered care plans.
• Manage patients between care settings.
• Conduct systematic patient-centered assessments.
• Monitor patient to care goals progress.

This applies to the following Programs and Years:

Over sixty organizations have earned NCQA Accreditation of Case Management for LTSS. See the NCQA Report Card for a directory of accredited organizations.

This applies to the following Programs and Years:

NCQA Case Management Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the operations of case management programs in provider, payer or community-based organizations. NCQA-Accredited organizations demonstrate they have the internal processes and service delivery structure to cost-effectively meet the complex patient needs to improve health or functional capability.

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:

NCQA Accreditation of Case Management for LTSS is a comprehensive, program designed to support organizations that coordinate LTSS. 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 and MCO requirements.

This applies to the following Programs and Years:

Organizations in operation for at least 6 months and coordinate LTSS are eligible for accreditation; for example:

• Area Agencies on Aging.
• Aging and Disability Resource Centers.
• Centers for Independent Living.
• Other home and community-based organizations.
• Health plans that coordinate LTSS that do not provide medical/behavioral health benefits.
• Case management organizations.
• Other organizations that coordinate LTSS.

 
NCQA-Accredited MBHOs or health plans that offer comprehensive medical benefits and manage LTSS are not eligible for this accreditation but can earn LTSS Distinction.

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:

More than forty organizations have earned NCQA Credentialing Accreditation. See the NCQA Report Card for a directory of accredited organizations.

This applies to the following Programs and Years:

Case Management Accreditation is for organizations that provide a broad range of case management services for complex and high-risk populations. Organizations are eligible if it:

• Provides case management services for at least 6 months.
• Delivers a broad range of case management services for complex or high-risk populations.
• Perform functions covered in the accreditation program or arrange for the functions to be performed, directly or through a service agreement.

Manage valid sample size of individuals for NCQA evaluation, where standards require patient file review.

This applies to the following Programs and Years:

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

This applies to the following Programs and Years:

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 standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

See a step-by-step process.

This applies to the following Programs and Years: