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 Provider Network Accreditation?

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

UM-CR-PN 2019

8.24.2018 What are the requirements for Physician and Hospital Quality Certification?

The standards and guidelines document is the publication that contains the requirements for certification. You can download this document for free through the NCQA eStore.

These standards include:

For Physician Quality:

  • Measures and Methods: Evaluates how an organization measures the quality and affordability of care provided by physicians, including:
    • Use of standard sources.
    • How cost is measured.
    • Defined methodologies.
    • Adherence to key principles.
    • Frequency of measurement.
  • Working with Physicians: Evaluates the transparency of the physician measurement program and how organizations work with physicians to respond to requests for corrections or changes.
  • Working with Customers: Looks at the organization’s level of transparency with customers (consumers and purchasers) regarding the details of its physician measurement program, and whether the organization works with consumers to address complaints.
  • Program Input and Improvement: Ensures that the organization seeks input and feedback on the design of its physician measurement program and on its reporting process, to improve the program’s value to physicians and customers.

For Hospital Quality:

  • Hospital Performance: The organization provides consumers and purchasers with information about how hospitals perform, to help them make decisions based on quality and cost. Organizations are evaluated on:
    • Hospital performance data: How they report payer quality and cost information to customers.
    • Decision support tools: Whether hospital reports support informed decision making.
    • Availability of information to customers: Whether they make hospital performance information available to consumers, purchasers and others.
    • Scope of hospitals: How they report performance information on hospitals in the network.
    • Working with hospitals on reporting: Whether they work with network hospitals on reporting.
    • Information about measurement: Whether they make information available about performance-based payments.
    • Feedback on Customer Reports: Whether they seeks customer feedback, with the goal of improving the usefulness of hospital performance reports.

PHQ

8.24.2018 Where can I find the Provider Network Standards and Guidelines?

8.24.2018 How does Physician and Hospital Quality Certification help our organization?

Health plans increasingly use physician quality information for value-based contracting, pay-for-performance programs, provider networks, physician tiering and more. Because payers make decisions based on these data, how data are measured is important.

The NCQA Certification process helps ensure that health plans and provider networks make decisions based on sound methodology, and assures patients and physicians that those decisions are transparent and that quality is not sacrificed to cost.

PHQ

8.24.2018 How does Provider Network Accreditation help my organization?

Use the NCQA Provider Network Accreditation standards to perform a gap analysis and determine improvement areas. The standards provide a framework for implementing industry best practices to:

  • Improve operational efficiencies.
    • Consistent monitoring of practitioner availability and accessibility of services.
    • Efficient collection and analysis of member-experience data.
    • Appropriate credentialing of practitioners and providers.
  • Elevate your organization’s reputation. Accreditation demonstrates that your organization has the processes and procedures to provide effective network management services.
  • Align with state requirements. Use accreditation standards to improve your internal operations and align with state requirements.
  • Improve contracting opportunities. Ability to reduce administrative responsibility for NCQA-Accredited organizations that delegate network management and credentialing activities.
 

UM-CR-PN 2019

8.24.2018 What is Physician and Hospital Quality Certification?

NCQA’s Physician and Hospital Quality Certification program evaluates how well organizations measure and report the quality and cost of physicians and hospitals. NCQA looks at measurement processes and methodology, transparency, collaboration and the balance between quality/cost when using the information to make decisions.

PHQ

8.24.2018 What is the price for the Medicaid Module Survey?

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

HP 2020

8.24.2018 Where can I find the Physician and Hospital Quality Standards and Guidelines?

8.24.2018 How does the Medicaid Module help my organization?

Meeting NCQA Medicaid Module standards can help organizations:

  • Streamline compliance activities. Compliance activities are reduced when the state uses NCQA Health Plan Accreditation and Medicaid Module standards as part of the Medicaid quality review.
  • Become more efficient. Reallocate key quality review resources to other Medicaid priorities.

HP 2020

8.24.2018 What other organizations have earned Utilization Management Accreditation?

More than 50 organizations have earned NCQA Utilization Management Accreditation. See the NCQA Report Card for a directory of accredited organizations.

UM-CR

8.24.2018 How long does it take to earn LTSS Distinction for Health Plans?

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 Provider Network Accreditation?

Several organizations have earned NCQA Provider Network Accreditation. See the NCQA Report Card for a directory of accredited organizations.

UM-CR-PN 2019