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 What other health plans have earned LTSS Distinction?

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 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 How long does it take to earn LTSS Distinction for Case Management Organizations?

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.

CM 2017

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 organizations are eligible for the 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 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 Where can I find the Accreditation/Certification Standards and Guidelines?

8.24.2018 What are the Accreditation/Certification requirements?

The Accreditation/Certification assesses an organization’s performance in the following requirement areas:

  • Workplace program implementation.
  • Protection of private health information.
  • Ability of services to empower participants to improve their health.

WHP 2013

8.24.2018 How does Accreditation/Certification help my organization?

NCQA Wellness and Health Promotion Accreditation/Certification focuses on services most desired by employers and health plans as well as expected by consumers. It provides a framework for organizations to implement industry best practices and apply evidence-based methods proven to support health and improve outcomes.

The standards help health and wellness organizations identify gaps for improvement and align their services with  those desired by potential contracting organizations.
 

WHP 2013

8.24.2018 What organizations are eligible for Physician and Hospital Quality Certification?

In general, any organization that operates a physician measurement program or hospital transparency program is eligible for certification. This includes, but is not limited to:

  • Health plans.
  • Provider networks.
  • Collaborative measurement organizations.
  • Information providers.

Organizations that meet these criteria are also eligible:

  • Operate a physician measurement program or hospital transparency program, as defined in the standards.
  • Are responsible for responding to complaints from consumers and to requests for change from physicians or hospitals based on the organization’s actions.
  • Comply with applicable federal, state and local laws and regulations, including requirements for licensure.
  • Operate without discrimination based on sex, race, creed or national origin.

Note: There are other eligibility criteria. Refer to the standards and guidelines document available in the NCQA eStore.

PHQ