Ledia Tabor, Director of Quality Solutions Group (Exchanges) at Tabor@ncqa.org or 202-995-1725.
Jennifer Zutz, Analyst of Quality Solutions Group (Exchanges) at Zutz@ncqa.org or 202-955-1720.
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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9.15.2012 Contact Information Who can I contact if I would like to learn if the Exchange Add-on Survey is the correct path for my plan?
9.15.2012 Basics What are the benefits for completing the Exchange Add-on Survey?
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.
This applies to the following Programs and Years:
9.15.2012 Basics I only have my Commercial HMO accredited. Can I bring my Exchange PPO through the Exchange Add-on Survey?
9.15.2012 Timing When is the first date that I can submit my application for the Exchanges Add-on Survey?
The application will be available by the end of September 2012 and can be submitted anytime; however, NCQA will not begin Exchange Add-on surveys until after January 1, 2013. Note that applications will only be accepted through December 31, 2013, as the Exchange Add-on Survey is a temporary strategy to help plans receive accreditation to qualify for Exchanges.
This applies to the following Programs and Years:
9.15.2012 Pricing What is due at the time of the actual survey date?
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:
9.15.2012 Basics What is the Exchange Add-on Survey?
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:
9.15.2012 Basics What is highest accreditation status I can receive through the Exchanges Add-on Survey?
9.15.2012 Basics What happens after the Exchanges Add-on Survey accreditation status expires?
The Exchange Add-on accreditation status is valid until your existing NCQA accredited product expires. Once this occurs, you must bring your Exchange product through the Renewal Evaluation Option which would include submission of HEDIS and CAHPS results starting in 2015.
This applies to the following Programs and Years:
9.15.2012 Timing What is the duration of the Exchanges Add-on Survey accreditation status?
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:
9.15.2012 Timing How long does it take to receive an accreditation status?
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:
9.15.2012 Basics What if I do not qualify for automatic accreditation because less than 70% of elements listed will be administered differently?
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.
This applies to the following Programs and Years:
9.15.2012 Basics How is the Exchange Add-on Survey different from the regular Add-on Survey?
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.
