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.

Filter Results
  • Save
  • Email
  • Print
expand all

8.24.2018 How do I get started with the Medicaid Module?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

This applies to the following Programs and Years:
HP 2018, 2019, 2020

8.24.2018 What is the process for earning Accreditation/Certification?

The first step to earning accreditation/certification 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 standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

See a step-by-step process.

This applies to the following Programs and Years:
WHP 2014, Cert, 2016, Cert|2013 WHP|Cert 2014|2016 WHP

8.24.2018 What is Long-term Services and Supports Distinction for Case Management Organizations?

NCQA LTSS Distinction for Case Management Organizations is a complementary program designed to support organizations that provide comprehensive clinical case management services and coordinate social services for LTSS populations. The program standards provide a framework for organizations to deliver efficient, effective person-centered care that meets people’s needs, helps keep people in their preferred setting and aligns with state requirements.

This applies to the following Programs and Years:
CM 2017

8.24.2018 What is CVO Certification?

NCQA CVO Certification evaluates the operations of organizations that verify practitioner credentials. Verification is accomplished through the primary source, through a recognized source or through a contracted agent of the primary source.

This applies to the following Programs and Years:
CVO 2016

8.24.2018 Are there additional resources for health plans seeking LTSS Distinction?

  • LTSS Best Practices Academy: Interactive forum for professionals to discuss strategies for coordinating quality long-term services and supports (LTSS) programs.
  • LTSS Roadmap: A compilation of resources to guide organizations through meeting Case Management and Health Plan Standards for LTSS.

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

8.24.2018 What organizations are eligible for the LTSS Distinction for Health Plans? What organizations are eligible?

An organization is eligible for the NCQA LTSS Distinction for a product/product line if:

  • The product/product line has a current NCQA Accreditation status, or
  • The product/product line is seeking NCQA Health Plan Accreditation.

Note:  NCQA conducts LTSS Distinction Surveys at the legal-entity level. Organizations undergoing Interim Survey are not eligible for LTSS distinction.

Health plans that coordinate LTSS and do not provide medical or behavioral services are not eligible for this distinction but can earn Accreditation of Case Management for LTSS.
 

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

8.24.2018 Where can I find the CVO Standards and Guidelines?

The Standards and Guidelines document can be found in the NCQA eStore.

This applies to the following Programs and Years:

8.24.2018 Are there additional resources for case management organizations seeking LTSS Distinction?

  • LTSS Best Practices Academy: Interactive forum for professionals to discuss strategies for coordinating quality long-term services and supports (LTSS) programs.
  • LTSS Roadmap: A compilation of resources to guide organizations through meeting Case Management and Health Plan Standards for LTSS.

This applies to the following Programs and Years:
CM 2017

8.24.2018 What other case management organizations have earned LTSS Distinction?

Organizations that have earned NCQA LTSS Distinction can be found in the NCQA Report Card.

This applies to the following Programs and Years:
CM 2017

8.24.2018 What is the process for earning Health Plan 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 standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

See a step-by-step process.

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

8.24.2018 Where can I find information to help me get started with the Medicaid Module?

This applies to the following Programs and Years:
HP 2018, 2019, 2020

8.24.2018 How does this LTSS Distinction help my case management organization?

Earning NCQA Accreditation of Case Management for LTSS can help organizations:

  • Become more efficient. A focus on coordinated care, training and measurement can help organizations reduce errors and duplicated services.
  • Integrate care better. Standards can help organizations improve communication between individuals, caregivers, providers, payers and other organizations that coordinate care.
  • Provide person-centered care. Standards focus on person-centered services, which can lead to better care planning and monitoring.
  • Support contracting needs. Standards align with the state needs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

This applies to the following Programs and Years:
CM 2017