A plan that scores less than 85 percent of the possible standards points must undergo a Resurvey within 12 months of the accreditation decision. The Resurvey look-back period is six months.
FAQ Directory
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.
Filter Results
-
Save
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
-
Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
-
Print
Print this page.
Print this page.
8.15.2012 Evaluation Options: Accreditation Surveys What is the Resurvey timeline for plans that score less than 85 percent of the possible points during the First Evaluation Option or the Renewal Evaluation Option?
8.15.2012 Evaluation Options: Accreditation Surveys How do plans add an Exchange accreditation to an existing accreditation?
Plans submit an application identifying whether their Exchange product will be operated the same as the accredited product. If 70 percent of the Interim Evaluation Option elements are the same, the Exchange product line receives automatic accreditation under the plans accreditation. If the majority of the operations are not the same, plans undergo a streamlined Add-On Survey with a six-month look-back period.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Standards and Guidelines Where can plans get information about standards points, HEDIS/CAHPS points for accreditation and reporting categories points?
Plans can look in Appendix 1: Standards Points for 2013, in the 2013 Standards and Guidelines, for a summary table of approximate points for each Evaluation Option. Appendix 2: HEDIS and CAHPS Points contains a summary table for approximate points for HEDIS/CAHPS measures. Appendix 3: Points by Reporting Category contains a summary table of points by reporting category.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring When must plans report HEDIS/CAHPS measures if they are going through the First Evaluation Option?
8.15.2012 Evaluation Options: Basics What is the difference between an Evaluation Option and a survey?
An Evaluation Option is defined by a distinct combination of requirements (standards and measures), scoring, statuses and length of accreditation. Health Plan Accreditation (HPA) 2013 has three Evaluation Options: Interim, First and Renewal. Plans are surveyed under one of the three evaluation options based on eligibility.
NCQA administers seven types of surveys to plans seeking accreditation: Full Survey, Follow-Up Survey, Resurvey, Add-On Survey, Expedited Survey, Corporate Survey and State and Federal Agency Survey.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Status and Scoring Will currently accredited plans be scored 50 points for HEDIS/CAHPS and 50 points for standards?
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring Plans that are not scored on HEDIS/CAHPS are capped at Accredited status. Will NCQA grandfather plans that earned Commendable status but were not scored on HEDIS/CAHPS?
8.15.2012 Evaluation Options: Accreditation Surveys May plans decline the accreditation status earned for a Full Survey?
Yes. A plan surveyed under the First Evaluation Option may decline the accreditation status (without penalty) at the completion of the survey, within 30 calendar days from receipt of its results. A plan that declines its accreditation status has the option to undergo a Follow-Up Survey within 12 months of receipt of its Full Survey results.
This applies to the following Programs and Years:
8.15.2012 UPDATED: Completely overturned denials excluded from file review Are overturned denials excluded from file review for only UM 9, Elements C and D, or from all elements in UM 9?
8.15.2012 Evaluation Options: Basics Which Evaluation Option should plans choose if they have not been accredited by NCQA?
Plans new to NCQA can earn accreditation through the Interim Evaluation Option or the First Evaluation Optionplans decide which Evaluation Option fits their needs. The two options give plans flexibility to choose based on their readiness and the comprehensiveness of their services.