FAQ Directory

Any organization that provides managed health care services may apply for the NCQA Health Plan Accreditation if it meets the following criteria:

• Operates under an insurance license (e.g., HMO, POS, PPO, EPO), and
• Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population, and
• Provides services through an organized delivery system that includes ambulatory and inpatient health care sites, and
• Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
• Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, and
• Reports audited HEDIS results for designated HEDIS measures and CAHPS ratings and composites, as required for the selected Evaluation Option.

This applies to the following Programs and Years:

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:

NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Standards help plans in:

• Quality Management and Improvement.
• Population Health Management.
• Network Management.
• Utilization Management.
• Credentialing and Recredentialing.
• Members’ Rights and Responsibilities.
• Member Connections.
• Medicaid Benefits and Services.

This applies to the following Programs and Years:

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:

NCQA Health Plan Accreditation is the most widely recognized, evidence-based program in the industry dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. It’s the only evaluation program that bases results on actual measurement of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures).

This applies to the following Programs and Years:

Any organization that provides managed health care services may apply for the NCQA Managed Behavioral Healthcare Organization Accreditation if it meets the following criteria:

• Has been in operation for at least six months, and
• Enrolls or receives enrollment of an identifiable eligible population that is eligible to access the network, and
• Provides comprehensive behavioral health care services through an organized delivery system across a continuum of care, and
• Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
• Has a process for monitoring, evaluating and improving the quality and safety of care.

This applies to the following Programs and Years:

More than 40 organizations have earned Credentials Verification Organizations Certification. A directory of Certified organizations can be found at the NCQA Report Card.

This applies to the following Programs and Years:

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:

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:

Any organization that provides credentials verification services can apply for Certification if it:

• Verifies practitioner credentials for health plans, MBHOs, physician organizations or health care organizations, and
• Provides verification services for at least six months before application, and 
• Performs verification activities for at least 50% of contracted practitioners, and
• Maintains the necessary credentials documentation, policies and procedures for NCQA to conduct the survey, and
• Obtains errors and omissions insurance for $1M–$2M.

This applies to the following Programs and Years:

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:

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: