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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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8.24.2018 What is the price for Utilization Management Accreditation?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

UM-CR 2019

8.24.2018 What is the process for earning Utilization Management Accreditation?

The first step to earning accreditation is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the utilization management standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

UM-CR 2019

8.24.2018 What organizations are eligible for Utilization Management Accreditation?

Utilization Management Accreditation is for organizations that provide full scope utilization management services. Eligible organizations:

  • Must not be licensed as an HMO, POS, PPO or EPO.
  • Must not be eligible for NCQA Accreditation as a health plan or an MBHO.
  • Must perform utilization management functions directly or through a contract.
  • Must perform utilization management activities for at least 50% of the members.
​Note: “Members” refers to membership of clients and organizations.

UM-CR 2019

8.24.2018 How long does it take to earn Utilization Management Accreditation?

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

UM-CR 2019

8.24.2018 Where can I find the Utilization Management Standards and Guidelines?

8.24.2018 What is Managed Behavioral Healthcare Organization Accreditation?

NCQA Managed Behavioral Healthcare Organization Accreditation is a comprehensive, evidence-based evaluation that reviews organizations to assure they use processes to deliver high-quality care and access. It provides a framework for organizations to align and improve operations in areas of quality improvement, care coordination, utilization management and credentialing and recredentialing and members’ rights.

MBHO 2019

8.24.2018 What organizations have earned CVO Certification?

More than 90 organizations have earned CVO Certification. A directory of Certified organizations can be found at the NCQA Report Card.

CVO

8.24.2018 What organizations are eligible for Managed Behavioral Healthcare Accreditation?

Any organization that provides managed health care services may apply for the NCQA Managed Behavioral Healthcare Organization Accreditation if it meets the following criteria:

  • Has been in operation for at least six months, and
  • Enrolls or receives enrollment of an identifiable eligible population that is eligible to access the network, and
  • Provides comprehensive behavioral health care services through an organized delivery system across a continuum of care, and
  • Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
  • Has a process for monitoring, evaluating and improving the quality and safety of care.

MBHO 2019

8.24.2018 What are the Utilization Management Accreditation requirements?

Utilization Management Accreditation assesses an organization’s performance in the following areas:

  • Improving operations through an internal QI process
  • Ensuring appropriate agreements and collaboration with clients
  • Maintaining member confidentiality
  • Ensuring involvement of appropriate professionals
  • Making fair and timely decisions
  • Handling member appeals in a fair and timely manner
  • Measuring member and provider experience

 
To see all program requirements, get the Standards & Guidelines document.
 

UM-CR 2019

8.24.2018 Where can I find the MBHO Standards and Guidelines?

8.24.2018 How does Utilization Management Accreditation help my organization?

NCQA Utilization Management Accreditation is designed to ensure that organizations pursuing accreditation can deliver fair and timely determinations to get the proper care to patients while effectively managing resources. The standards provide a framework for adopting industry best practices to objectively and efficiently evaluate the appropriateness of requested health care services.

UM-CR 2013

8.24.2018 How does MBHO Accreditation help my organization?

  • Managed Behavioral Healthcare Organization Accreditation:
    • Provides a framework for internal quality improvement in:
    • Quality Management and Improvement.
    • Care Coordination.
    • Utilization Management.
    • Credentialing and Recredentialing.
    • Members’ Rights and Responsibilities.
  • Elevates your organization’s status in the marketplace.
  • Improves contracting opportunities.
  • Satisfies health plan requirements.

MBHO 2019