FAQ Directory

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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:

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.

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:

Organizations that have earned NCQA LTSS Distinction can be found in the NCQA Report Card.

This applies to the following Programs and Years:

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:

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.

This applies to the following Programs and Years:

• 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:

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.

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:

NCQA LTSS Distinction for Health Plans is a complementary program designed to support health plans coordinating LTSS. The program standards provide a framework for organizations to deliver efficient, effective person-centered care that meets people’s needs, helps keep people in their preferred setting and aligns with state requirements.

This applies to the following Programs and Years: