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.
1. Allows you to market your Exchange product as NCQA Accredited to Exchanges and potential members.
2. Allows you to meets Exchange accreditation requirements, for those Exchanges that require Exchange _specific Accreditation.
3. Its a streamlined and efficient process, where plans need to attest that they will operate their Exchange the same as their accredited product. Unless there are many differences, NCQA will not review further documentation.
Once you submit your application, NCQA will determine if your organization is eligible for automatic accreditation. If you apply before February 1, 2013 and NCQA determines your organization is eligible for automatic accreditation then NCQA will award the accreditation status in the first quarter of 2013. If you apply after February 1, 2013 and NCQA determines your organization is not eligible for automatic accreditation then NCQA will award the accreditation status about two months after you apply.
If upon review of your application, NCQA determines that your organization is eligible for automatic accreditation, NCQA staff will contact you to schedule a date to start your Exchange Add-on survey and issue an ISS tool to you to complete and submit on the start date. If your organization achieves accreditation then the status will be awarded about three months after the start of the survey.
Note that NCQA posts accreditation status updates on its Web site once a month on the 15th of each month for statuses effective as of the end of the previous month.
The Exchanges Add-on Survey accreditation status is valid until your existing accredited products accreditation status expires.
For example:
You have Commercial HMO accreditation, which expires in January 2015.
You bring in your Exchange HMO for accreditation now, through the Exchanges Add-on Survey.
Your accreditation status for the Exchange product line is valid until your Commercial HMO expires in January 2015.
The Exchange Add-on Survey is a streamlined version of the regular Add-on Survey:
Plans do not submit HEDIS/CAHPS
Since HEDIS/CAHPS are not submitted, plans are capped at Accredited status.
NCQA reviews documentation of standards only when the organization manages functions differently from key elements. (The Application defines which standards are required and how many functions are permitted to be performed differently).
No file review for the Exchange product line.
If an organization does not qualify for automatic Accreditation for its Exchange product line, NCQA will survey those elements that it will administer differently using NCQAs existing add-on survey process. The survey will only consist of the off-site portion of the survey process and will not include a file review.
The Exchange Add-on Survey evaluates plans on a subset of standards and elements listed in Section 7 of the NCQA HPA Exchange Add-on Survey Application. For an organization that will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines, NCQA will award Accreditation to the Exchange product line without conducting a formal survey. An organization qualifies for automatic Accreditation if it attests that it will administer 70% or more of the elements listed in Section 7 in the same manner.
