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 organizations are eligible for the LTSS Distinction?

8.24.2018 How long does it take to earn Provider Network 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-PN 2018, 2019

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.

This applies to the following Programs and Years:
HP 2018, 2019, 2020

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.

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

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.

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

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.

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

8.24.2018 Where can I find the LTSS Distinction Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA eStore.

This applies to the following Programs and Years:
HP 2017, 2018, 2019, 2020

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

Find the Standards and Guidelines document in the NCQA eStore.

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

8.23.2018 Where can I find information to help me get started with Credentialing Accreditation?

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

8.23.2018 What is Credentialing Accreditation?

NCQA Credentialing Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope credentialing services, which include verifying practitioner credentials, designated credentialing-committee review of practitioners and monitoring practitioner sanctions.

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

8.23.2018 What is the process for earning Credentialing 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 CR standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

See a step-by-step process.

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

8.23.2018 How do I get started with Credentialing Accreditation?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

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