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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8.20.2018 How does this Accreditation help my organization?

Earning NCQA’s 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 needs of states and MCOs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

This applies to the following Programs and Years:
CM-LTSS 2017

8.20.2018 What other organizations have earned Case Management Accreditation?

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:
CM 2017, 2014

8.20.2018 How long does it take to earn Accreditation?

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:
CM-LTSS 2017

8.20.2018 What is the process for earning 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 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:
CM-LTSS 2017

8.20.2018 What is the price for this 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:
CM-LTSS 2017

8.20.2018 How do I get started with LTSS Accreditation? How-do-I-get-started-with-LTSS-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:
CM-LTSS 2017

8.17.2018 General Who makes the final determination of whether a practice achieves PCMH PRIME Certification?

Practices seeking PCMH PRIME Certification must submit documentation to NCQA for review or participate in an NCQA virtual review.  NCQA reviewers evaluate the evidence to determine whether the practice has met the PCMH PRIME criteria.  NCQA provides its assessment to the HPC.  Based on this assessment, the HPC then scores the practice and determines whether it has met PCMH PRIME Certification requirements.

This applies to the following Programs and Years:

8.17.2018 General Is the PCMH PRIME program mandatory for primary care practices in Massachusetts?

No; PCMH PRIME is a voluntary program. Eligible practices (see below) are encouraged to participate, but are not required to participate.

This applies to the following Programs and Years:

8.17.2018 General Our practice has questions about the PCMH PRIME Certification program. Who can we contact?

If your practice has additional questions about PCMH PRIME, you can: 

This applies to the following Programs and Years:

8.17.2018 General What does it mean to be on the “Pathway to PCMH PRIME”?

Some practices seeking PCMH PRIME Certification may be designated by the HPC as on the “Pathway to PCMH PRIME.”  Practices qualify for Pathway to PCMH PRIME status if they are currently NCQA PCMH Recognized (at any level except PCMH 2011 Level 1) and commit to applying to NCQA for PCMH PRIME Certification within 18 months of submitting a PCMH PRIME application to the HPC.

This applies to the following Programs and Years:

8.17.2018 General How long is the PCMH PRIME Certification good/valid for?

The HPC’s current policy is that PCMH PRIME Certification lasts for up to three years. This differs from NCQA’s PCMH 2017 Recognition program which has a one-year recognition period. A practice must maintain its NCQA PCMH Recognition throughout that period in order to maintain PCMH PRIME Certification.  If NCQA Recognition lapses while the practice is PCMH PRIME Certified, the practice will need to re-attain NCQA Recognition within 6 months in order to keep their PCMH PRIME status.    

 

A PCMH PRIME Certified practice could choose to renew its PCMH PRIME Certification before the three-year expiration date if the practice is renewing its NCQA PCMH Recognition and wants to simultaneously renew PCMH PRIME Certification in order to align the two recognition periods.

This applies to the following Programs and Years:

8.17.2018 PP 11 Can pediatric practices receive credit if they screen mothers who have recently given birth for postpartum depression?

Yes, if the pediatric practice conducts postpartum depression screening during an infant care visit, the practice may receive credit for this diagnostic. The practice does not necessarily have to create a new patient record, nor store the results of the screening in the infant’s record, so long as it can provide the required documentation to NCQA. 

This applies to the following Programs and Years: