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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 How does the LTSS Distinction for Health Plans help my 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.

HP 2020

8.24.2018 What other health plans have earned LTSS Distinction?

8.24.2018 What is the price for the LTSS Distinction for Case Management Organizations?

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

CM 2017

8.24.2018 How long does it take to meet the Medicaid Module requirements?

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.

HP 2020

8.24.2018 What organizations are eligible for the Medicaid Module?

An organization is eligible for the NCQA Health Plan Medicaid Module if:

  • Its Medicaid product line has a current NCQA Accreditation status as a First or Renewal Survey, or
  • It is seeking accreditation for its Medicaid product line under NCQA HP Accreditation as an Interim, First or Renewal Survey.

HP 2020

8.24.2018 What organizations are eligible for Provider Network Accreditation?

To be eligible for Provider Network Accreditation, an organization must:

  • Not be licensed as an HMO, POS, PPO or EPO.
  • Not be eligible for NCQA Accreditation as a health plan or an MBHO.
  • Perform Provider Network functions directly or through contractual agreement.
  • Perform Provider Network activities for at least 50% of the provider network.
 

Note: A “practitioner network” is the practitioner network of clients and organizations.

UM-CR-PN 2019

8.24.2018 What are the Provider Network Accreditation requirements?

Provider Network Accreditation assesses an organization’s performance in the following key areas:

Credentialing and recredentialing
Network management
  • Protecting information
  • Maintaining adequate network
  • Verifying credentials
  • Providing access to appointments
  • Ongoing monitoring of sanctions and complaints
  • Continuity and coordination of care
 
  • Providing directory information
 

UM-CR-PN 2019

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.

CM 2017

8.24.2018 Where can I find the LTSS Distinction for Case Management Organizations Standards and Guidelines?

8.24.2018 How long will it take to earn Accreditation/Certification?

The typical evaluation timeframe, from application submission to decision, is 12 months. This depends on the organization’s readiness, as some organizations may already be working within NCQA guidelines.

WHP 2013

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.

CM 2017

8.24.2018 Where can I find the Accreditation/Certification Standards and Guidelines?