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.

Filter Results
  • Save
  • Email
  • Print
expand all

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

8.24.2018 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 are the Provider Network Accreditation requirements?

Provider Network Accreditation assesses an organization’s performance in the following key areas:

Credentialing and recredentialing
Network management
  • Protecting information
  • Maintaining adequate network
  • Verifying credentials
  • Providing access to appointments
  • Ongoing monitoring of sanctions and complaints
  • Continuity and coordination of care
 
  • Providing directory information
 

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 What is the price for the LTSS Distinction for Case Management Organizations?

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:
CM 2017

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

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 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 What are the Credentialing Accreditation requirements?

Credentialing Accreditation assesses an organization’s performance in the following areas:

  • Internal Quality Improvement Process
  • Agreement and Collaboration With Clients
  • Protecting Credentialing Information
  • Credentialing Policies
  • Credentialing Committee
  • Credentialing Verification
  • Recredentialing Cycle Length
  • Ongoing Monitoring
  • Notification to Authorities and Practitioner Appeal
    Rights
  • Assessment of Organizational Providers
  • Delegation of CR

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 price for Credentialing 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 2017, 2016|UM-CR-PN 2018, 2019

8.23.2018 What organizations are eligible for Credentialing Accreditation?

Credentialing Accreditation is for organizations that provide full scope credentialing services. Eligible organizations:

  • Must not be licensed as an HMO, POS, PPO or EPO.
  • Must not be eligible for NCQA Accreditation as a health plan or an MBHO.
  • Must perform credentialing functions directly or through a contract.
  • Must perform credentialing activities for at least 50% of a practitioner network.

Note: A “practitioner network” is the practitioner network of clients and organizations.

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