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 other case management organizations have earned LTSS Distinction?

8.24.2018 What is Long-term Services and Supports Distinction for Health Plans?

NCQA LTSS Distinction for Health Plans is a complementary program designed to support health plans coordinating LTSS. 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.

HP 2020

8.24.2018 What is the price for Wellness and Health Promotion Accreditation/Certification?

Pricing is based on multiple factors. Full pricing information can be obtained by submitting a request through My NCQA.

WHP 2013

8.24.2018 How does Health Plan Accreditation help my organization?

  • Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based, best practices help plans improve in areas of:
    • QI process.
    • Population health management.
    • Practitioner network and access to care.
    • Utilization management processes.
    • Credentialing and recredentialing processes.
    • Members’ rights and responsibilities.
    • Member connection.
    • Medicaid service requirements.
  • Satisfy state requirements and employer needs. The standards align with many state requirements.

HP 2020

8.24.2018 What are the CVO Certification requirements?

CVO Certification assesses an organization’s performance in the following requirement areas:

  • Internal Quality Improvement Process
  • Protecting Credentialing Information
  • Verifying credentials.

NCQA’s CVO Certification program offers the following 11 certification options:

  • License to Practice
  • State Licensing Board Sanctions
  • DEA or CDS Certification
  • Medicare/Medicaid Sanctions
  • Education and Training
  • Practitioner Application Processing
  • Board Certification Status
  • Application and Attestation Content
  • Work History
  • Ongoing Monitoring of Sanctions
  • Malpractice Claims History
  

CVO 2016

8.24.2018 What organizations are eligible Wellness and Health Promotion Accreditation/Certification?

Any organization that provides wellness and health promotion services can apply for accreditation/certification if it:

  • Provides wellness services, either directly or through a service agreement, and
  • Provides wellness services for at least three months before survey submission, and 
  • Has a process for monitoring, evaluating and improving the quality and safety of services provided to eligible participants.

WHP 2013

8.24.2018 Where can I find the Health Plan Accreditation Standards and Guidelines?

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

8.24.2018 What other organizations have earned Health Plan Accreditation?

Over 1,000 health plan products have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

HP 2020

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 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 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