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 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 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 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 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 is the price for the LTSS Distinction for Health Plans?

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:
HP 2017, 2018, 2019, 2020

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 other health plans have earned LTSS Distinction?

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

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

8.24.2018 What is the price for the Medicaid Module Survey?

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:
HP 2018, 2019, 2020

8.24.2018 What organizations are eligible for the Medicaid Module?

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:
HP 2018, 2019, 2020

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 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