FAQ Directory

This applies to the following Programs and Years:

This applies to the following Programs and Years:

Earning NCQA Accreditation of Case Management for LTSS can help organizations:

• Become more efficient. A focus on coordinated care, training and measurement can help organizations reduce errors and duplicated services.
• Integrate care better. Standards can help organizations improve communication between individuals, caregivers, providers, payers and other organizations that coordinate care.
• Provide person-centered care. Standards focus on person-centered services, which can lead to better care planning and monitoring.
• Support contracting needs. Standards align with the state needs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

This applies to the following Programs and Years:

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:

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

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:

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

This applies to the following Programs and Years:

An organization is eligible for the NCQA Health Plan Medicaid Module if:

• Its Medicaid product line has a current NCQA Accreditation status as a First or Renewal Survey, or
• It is seeking accreditation for its Medicaid product line under NCQA HP Accreditation as an Interim, First or Renewal Survey.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

Find the standards and guidelines document, the survey tool and the application in the NCQA eStore.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years: