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 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 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 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 What are Managed Behavioral Healthcare Accreditation requirements?

The standards, provide a framework for implementing best practices to improve:

  • Quality Management and Improvement: Monitor, evaluate and improve the quality and safety of care.
  • Care Coordination: Coordinate medical care and behavioral healthcare for its members.
  • Utilization Management: Notifies members and practitioners about coverage decisions within required time frames.
  • Credentialing and Recredentialing: Verifies the credentials of the practitioners in its network.
  • Members’ Rights and Responsibilities: Written members’ rights and responsibilities policy exist.

To see the program requirement details, get the Standards & Guidelines document.

MBHO 2019

8.24.2018 What is Utilization Management Accreditation?

NCQA Utilization Management Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope utilization management services, which include using evidence-based criteria, relevant clinical information and qualified health professionals to make utilization management decisions.

UM-CR 2013

8.24.2018 What is the price for Health Plan Accreditation?

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

HP 2020

8.24.2018 What is Provider Network Accreditation?

NCQA Provider Network Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the accessibility and transparency of organization networks and credentialing of practitioners and providers. NCQA-Accredited organizations demonstrate they have the internal processes and procedures to effectively manage access to care and member experience while ensuring that practitioners and providers are appropriately credentialed.

UM-CR-PN 2019

8.24.2018 How long does it take to earn Health Plan 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.

HP 2020

8.24.2018 What other organizations have earned Managed Behavioral Healthcare Accreditation?

More than 30 organizations have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

MBHO 2019