Summer Changes to Accred, Cert Programs Will Spread

June 27, 2023 · Andy Reynolds

Two process improvements this summer to NCQA Accreditation and Certification programs affecting more than 1,700 customers are a preview of changes coming to other NCQA programs and almost 600 more customers in the next few years.

The upgrades debuting this summer are to:

  • File Review System: How NCQA manages accreditation and eCertification file review.
  • Delegation: How organizations document the work they assign to their partners or contractors.
Changes to the File Review System (FRS) 
Health Plan AccreditationUtilization Management
Credentialing
Provider Network
Accreditation

Case Management – Long-Term Services and Support Accreditation
WHAT
we’re launching
Online system to manage the file review process for NCQA Accreditation and Certification surveys.
Effective July 1, 2022Effective July 1, 2023
WHY
we’re doing this
To automate how we collect file data, file selections, record file findings and conduct self-assessments for file monitoring and mock audits.
HOW
this helps customers
More efficient than the previous, manual method using Excel workbooks
WHEN
file info is due
The file universe is still due on date of survey submission, but can now be uploaded to the new File Review System. Final file selections are still released via the system 10 business days before onsite review. On the date of the scheduled onsite, the NCQA surveyor uses the system to record file scores.
WHERE
to get tools to help you
See the resources in your purchased IRT license.
WHERE
to read background
In our blog: “One-Stop Shop” Eases Accreditation’s Logistical Load
WHO
this affects
1,167
customers/customer products
280
customers/customer products
103
customers/customer products

We plan to apply these changes in the next 1-2 years to other NCQA programs that use file review:

 

Changes to Delegation Process
Health Plan AccreditationHealth Equity AccreditationUtilization Management
Credentialing
Provider Network
Accreditation
Case Management – Long-Term Services and Support Accreditation
WHAT
we’re launching
New or enhanced delegation system for surveys whose delegation information is due…
Enhancements effective July 31, 2023Under Standards Year 2023+
(July 1, 2023)
Effective July 31, 2023
*Subject to change
Effective July 31, 2023
WHY
we’re doing this
To enhance the system launched 2022.To automate the process for reporting and processing delegation data.
HOW
this helps customers
Simplifies submission and selection of delegate information.
WHEN
delegation info is due
6 weeks before survey submission.
WHERE
to get tools to help you
See resources in your purchased IRT license.
WHERE
to read background
December 2022 email to customerNA
WHO
this affects
1,167
customers/customer products
194
customers/customer products
280
customers/customer products
103
customers/customer products
  • Delegate selections (if required) are provided to organizations 4 weeks before submission. Selected delegates will be indicated in the delegation module and will also be populated into applicable delegation oversight elements in the core IRT survey tool.
  • Delegation information may be entered directly into the module or submitted in an updated worksheet, available in the Organization Background section of the IRT.
  • The new delegation module was designed to be user-friendly. We welcome your feedback to make sure we are meeting that goal. If you have recommendations for other improvements, please contact us through your MyNCQA account.
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