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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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 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.
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.
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.
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.
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.
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).
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.
