FAQ Directory

Find the Standards and Guidelines document in the NCQA eStore.

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:

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

• Identification and assessment
• Care planning
• Care monitoring
• Care transitions
• Measurement and quality improvement

This applies to the following Programs and Years:

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

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:

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:

The PCMH PRIME Certification program launched on January 1, 2016.

This applies to the following Programs and Years:

First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME.

Once your practice has submitted the HPC application and is ready for next steps with NCQA, you should apply through the new NCQA Q-PASS system. The PCMH PRIME application is separate from the PCMH application in Q-PASS. Practices may apply for PCMH PRIME Certification separately or concurrently with the PCMH Recognition process and Annual Reporting.

• For PCMH 2011 (except Level 1) and PCMH 2014 Level 1 or 2 Recognized practices:
  • Practices planning to undergo the PCMH 2017 Recognition process in the near future are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact Government Recognition Initiative and Projects (GRIP) Staff at pcmh-grip@ncqa.org for more information.
  • Recognized practices not planning to renew their PCMH Recognition in the near future may apply for PCMH PRIME Certification separately, at any time.

§  For PCMH 2014 Level 3 or PCMH 2017 Recognized practices:

• Practices that are maintaining PCMH Recognition through the Annual Reporting process may apply for PCMH PRIME Certification concurrently or separately from the Annual Reporting process, whichever is most convenient for the practice.

• For Practices without PCMH Recognition:
  •  Practices must attain PCMH Recognition in order to be eligible for PCMH PRIME Certification. Such practices are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact GRIP Staff, pcmh-grip@ncqa.org, for more information.

This applies to the following Programs and Years:

The PCMH PRIME review process varies depending on whether a practice applies to PCMH PRIME concurrently with a PCMH 2017 survey or applies to PCMH PRIME only (to supplement previously earned PCMH Recognition).

·        Practices applying to PCMH PRIME concurrently with a PCMH 2017 survey will submit PCMH PRIME evidence as part of the PCMH 2017 virtual review process. The PCMH 2017 review process may take up to 12 months but varies by individual practice timelines and capabilities. This process includes up to three virtual check-ins lasting up to two hours each.  Practices applying only to PCMH PRIME or to PCMH PRIME concurrently with Annual Reporting will upload all evidence to Q-PASS without participating in a virtual check-in. NCQA evaluates a practice’s documentation for PCMH PRIME within 60 days of receipt. 

Once the PCMH PRIME documentation review is complete, NCQA provides its assessment results to the HPC.  The HPC issues a final scoring decision to the practice within 15 business days of receiving results from NCQA.

This applies to the following Programs and Years:

The HPC’s current policy is that PCMH PRIME Certification lasts for up to three years. This differs from NCQA’s PCMH 2017 Recognition program which has a one-year recognition period. A practice must maintain its NCQA PCMH Recognition throughout that period in order to maintain PCMH PRIME Certification.  If NCQA Recognition lapses while the practice is PCMH PRIME Certified, the practice will need to re-attain NCQA Recognition within 6 months in order to keep their PCMH PRIME status.    

A PCMH PRIME Certified practice could choose to renew its PCMH PRIME Certification before the three-year expiration date if the practice is renewing its NCQA PCMH Recognition and wants to simultaneously renew PCMH PRIME Certification in order to align the two recognition periods.

This applies to the following Programs and Years:

No. The PCMH PRIME Certification program is limited to practices in Massachusetts. Practices outside of Massachusetts offering integrated behavioral health services are encouraged to apply to NCQA’s Distinction in Behavioral Health Integration, which is available nationally.  
 

This applies to the following Programs and Years:

Practices seeking PCMH PRIME Certification must submit documentation to NCQA for review or participate in an NCQA virtual review.  NCQA reviewers evaluate the evidence to determine whether the practice has met the PCMH PRIME criteria.  NCQA provides its assessment to the HPC.  Based on this assessment, the HPC then scores the practice and determines whether it has met PCMH PRIME Certification requirements.

This applies to the following Programs and Years: