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Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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4.15.2026 Combining commercial and Exchange product lines for reporting UM rates May an organization combine commercial and Exchange product lines when reporting Utilization Management (UM) rates for UM 1, Elements B–H?

No. For NCQA Health Plan Accreditation, NCQA reviews and scores UM 1, Elements B–H separately for each product line brought forward for Accreditation. Organizations may not combine any product lines—including commercial and Exchange—when reporting and evaluating UM rates for UM 1, Elements B–H.

Applicable standards: 

  • Health Plan Accreditation: UM 1, Elements B-H.  
  • Behavioral Health Accreditation: UM 1, Elements B-F. 
  • Utilization Management Accreditation: UM 3, Elements B-H. 

This applies to the following Programs and Years:
HP 2026|UM 2026|BHA 2026