FAQ Directory

NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. The standards provide a framework for adopting industry best practices to accurately and efficiently credential and recredential health care professionals—ensuring that medical organizations employ qualified professionals and align with state requirements.

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:

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:

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:

More than 90 organizations have earned NCQA Credentialing Accreditation. See the NCQA Report Card for a directory of accredited organizations.

This applies to the following Programs and Years:

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:

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

This applies to the following Programs and Years:

A list of the 13 PCMH PRIME criteria can be found on the HPC website here. The full PCMH PRIME requirements, including the criteria and all documentation requirements, is available for download at no cost from the NCQA Store.

This applies to the following Programs and Years:

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

This applies to the following Programs and Years:

More than forty organizations have earned NCQA Credentialing Accreditation. See the NCQA Report Card for a directory of accredited organizations.

This applies to the following Programs and Years:

NCQA Case Management Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the operations of case management programs in provider, payer or community-based organizations. NCQA-Accredited organizations demonstrate they have the internal processes and service delivery structure to cost-effectively meet the complex patient needs to improve health or functional capability.

This applies to the following Programs and Years:

Organizations in operation for at least 6 months and coordinate LTSS are eligible for accreditation; for example:

• Area Agencies on Aging.
• Aging and Disability Resource Centers.
• Centers for Independent Living.
• Other home and community-based organizations.
• Health plans that coordinate LTSS that do not provide medical/behavioral health benefits.
• Case management organizations.
• Other organizations that coordinate LTSS.

 
NCQA-Accredited MBHOs or health plans that offer comprehensive medical benefits and manage LTSS are not eligible for this accreditation but can earn LTSS Distinction.

This applies to the following Programs and Years: