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.

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8.15.2012 Evaluation Options: Accreditation Surveys May a plan that was denied accreditation reapply for accreditation in less than a year from the date of the Denied status?

Yes, a plan may apply for a new Accreditation Survey (called an Expedited Survey) in less than a year under specific circumstances, including:

The plan was denied accreditation under the Interim Evaluation Option and may reapply after three months.

The organization demonstrates to NCQAs satisfaction that the issues identified in the original survey can be corrected within a six- to nine-month time frame as a result of the organizations activity.

Correction of the issues would raise the organizations accreditation status in a new survey.

To qualify for an Expedited Survey, a plan must submit a written request listing the steps it has taken to address the substantive issues that led to its Denied Accreditation status.

This applies to the following Programs and Years:

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?

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.

This applies to the following Programs and Years:

8.15.2012 Evaluation Options: Accreditation Surveys How soon will plans be able to earn accreditation for their Exchange product line?

NCQA-Accredited plans can earn accreditation for their Exchange product line as early as February 2013. Plans without previous NCQA Accreditation can apply for the Interim Evaluation Option as early as September 2012 and have their Exchange product line accredited as early as October 2013.

This applies to the following Programs and Years:

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 Evaluation Options: Basics Which Evaluation Option should plans with New Health Plan accreditation apply for next?

Plans with NHP accreditation must apply for the Renewal Evaluation Option with a 12-month look-back period.

This applies to the following Programs and Years:

8.15.2012 Evaluation Options: Standards and Guidelines Several elements in the First Evaluation Option require annual evaluation, even though the Evaluation Option has a six-month look-back period for all other elements. How do plans meet this annual requirement?

NCQA will expand the look-back period if it is necessary for plans to demonstrate that performance requirements are met and to produce an adequate sample for file reviews. For annual requirements, plans must complete the activity at least once during the prior year.

This applies to the following Programs and Years:

8.15.2012 Evaluation Options: Status and Scoring Is it possible for plans to score higher than Accredited status during any First Evaluation Option years?

Yes. Plans that notify NCQA that they want to be scored on HEDIS/CAHPS measures by December 31 (before the June HEDIS reporting date) may score higher than Accredited status.

This applies to the following Programs and Years:

8.15.2012 Evaluation Options: Status and Scoring How are plans scored that do not report HEDIS/CAHPS?

Standards-only accreditation scoring is based on 50 points.

This applies to the following Programs and Years:

8.15.2012 Evaluation Options: Basics How are the Interim Option and the First Evaluation Option different?

The Interim Evaluation Option has half of the number of elements as the First Evaluation Option, focuses on policies and procedures and is valid for 18 months.

The First Evaluation Option is valid for 36 months and focuses on policies and procedures, initial measurement and analysis of programs and file review.

Plans going through the Interim Evaluation Option can earn Interim status (HEDIS/CAHPS reporting is not required); plans going through the First Evaluation Option can earn either Provisional or Accredited status (if they are not scored on HEDIS/CAHPS).

Reporting is required during the third annual HEDIS reporting cycle for organizations going through the First Evaluation Option, which also gives plans the option to be scored on HEDIS/CAHPS results, allowing them to earn an accreditation status higher than Accredited.

This applies to the following Programs and Years:

8.15.2012 Evaluation Options: Basics For which Evaluation Options are organizations eligible if their accreditation has expired?

A plan whose accreditation status has expired or has been withdrawn for less than two years is eligible for the Renewal Evaluation Option with a 24-month look-back period.

A plan whose accreditation expired more than two years ago is eligible for accreditation through the Interim Evaluation Option or First Evaluation Options with a six-month look-back period.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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: