FAQ Directory

No. By "in print," NCQA means a printed copy of a document that is made available (e.g., by mail) to eligible individuals who may not have access to the Internet.

This applies to the following Programs and Years:

The Exchange Add-on Survey is a streamlined accreditation approach available for organizations that currently have NCQA Health Plan Accreditation for any product line (commercial, Medicaid or Medicare) and wants to add its Exchange product line to its existing Accreditation.

This applies to the following Programs and Years:

Base fee is $15,000 if an organization qualifies for automatic accreditation and $22,500 if an organization must go through a review. However, this includes the already submitted application submission fee. Actual additional amount required prior to NCQA awarding automatic accreditation is $5,000 or prior to the survey date if a review is required is $12,500. NCQA will bill organizations for the remainder of the fees due prior to awarding automatic accreditation or conducting the survey.

This applies to the following Programs and Years:

Plans coming through the Exchange Add-on Survey are capped at Accredited status because HEDIS/CAHPS is not included.

This applies to the following Programs and Years:

Yes. As long as the organization will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

Although the event/diagnosis criteria do not specifically state "and/or," it is implied. As long as there are two outpatient visits or two nonacute inpatient discharges, or one outpatient visit and one nonacute inpatient discharge, with a diagnosis of RA, the member meets the criteria for eligible population.

This applies to the following Programs and Years:

No. GFR testing is not currently acceptable for the Medical Attention for Nephropathy indicator. Clinical experts determined that certain characteristics, such as age, sex and race, may impact the effectiveness of such tests for monitoring nephropathy. If a member was determined to have impaired kidney function based on a GFR test, it is expected that there would be other documentation in the medical record that would make the member compliant for the nephropathy indicator (e.g., documentation of a visit to a nephrologist or documentation of medical attention for any appropriate conditions listed in the specifications).

This applies to the following Programs and Years:

Plans report HEDIS/CAHPS measures during the third annual HEDIS reporting cycle of their accreditation status. For example, if an organization receives a status in September 2014, it must submit audited HEDIS/CAHPS results in June 2017.

This applies to the following Programs and Years:

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: