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 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.

This applies to the following Programs and Years:
MBHO 2017, 2018, 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.

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

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 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.
 

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 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.

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 2019

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.

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 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.

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 2019

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

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:
UM-CR 2017|UM-CR-PN 2018, 2019

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.

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

8.24.2018 Where can I find the MBHO Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA eStore.

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

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.

This applies to the following Programs and Years:
UM-CR 2017, 2016, 2013|UM-CR-PN 2018, 2019

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.

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