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 Where can I find the MBHO Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA eStore.

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

8.24.2018 What organizations are eligible for CVO Certification?

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:

8.24.2018 Where can I find the CVO Standards and Guidelines?

The Standards and Guidelines document can be found in the NCQA eStore.

This applies to the following Programs and Years:

8.24.2018 How does CVO Certification help my organization?

NCQA CVO Certification is designed to ensure organizations can maintain a high-quality network for members and contracted clients. The standards provide a framework for adopting industry best practices to promote accurate and efficient verification of practitioner credentials—ensuring that medical organizations employ qualified professionals and align with state requirements.

This applies to the following Programs and Years:

8.24.2018 What is the price for CVO Certification?

Pricing is based on multiple factors. Full pricing information can be obtained by submitting a request through My NCQA.

This applies to the following Programs and Years:

8.24.2018 How long will it take to earn CVO Certification?

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:

8.24.2018 How long will it take to earn Accreditation/Certification?

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:
WHP 2014, Cert, 2016, Cert|2013 WHP|Cert 2014|2016 WHP

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 does the LTSS Distinction for Health Plans help my organization?

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:
HP 2017, 2018, 2019, 2020

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.
 

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

8.24.2018 How long does it take to meet the Medicaid Module requirements?

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 2018, 2019, 2020

8.24.2018 What organizations are eligible for Physician and Hospital Quality Certification?

In general, any organization that operates a physician measurement program or hospital transparency program is eligible for certification. This includes, but is not limited to:

  • Health plans.
  • Provider networks.
  • Collaborative measurement organizations.
  • Information providers.

Organizations that meet these criteria are also eligible:

  • Operate a physician measurement program or hospital transparency program, as defined in the standards.
  • Are responsible for responding to complaints from consumers and to requests for change from physicians or hospitals based on the organization’s actions.
  • Comply with applicable federal, state and local laws and regulations, including requirements for licensure.
  • Operate without discrimination based on sex, race, creed or national origin.

Note: There are other eligibility criteria. Refer to the standards and guidelines document available in the NCQA eStore.

This applies to the following Programs and Years: