FAQ Directory

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:

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:

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:

Behavioral health conditions (mental illnesses and substance use disorders) suffer from both under-diagnosis and delayed diagnosis. This is a serious public health problem nationally and across the Commonwealth. Untreated behavioral health conditions contribute to morbidity and increase the total cost of care. The gap in care and treatment for behavioral health conditions requires action and a coordinated effort by providers and payers to ensure that patients get the care they need, before illness is severe and results in a crisis situation (e.g., avoidable ED visit or inpatient admission). Integrating behavioral health—including appropriate screening for behavioral health conditions (and treatment, when appropriate)—is critical in the primary care setting.   

This applies to the following Programs and Years:

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:

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

• Speak to an NCQA representative by calling 617-996-0081.
• Submit questions via NCQA’s Program/Policy Clarification Support (PCS) system at https://my.ncqa.org. 
• E-mail your questions to HPC staff at HPC-Certification@state.ma.us.

This applies to the following Programs and Years:

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:

The program is open to practices in Massachusetts currently recognized as: 

• NCQA PCMH 2011, Level 2 or 3. 
• NCQA PCMH 2014, Level 1, 2 or 3. 
• NCQA PCMH 2017

A practice that is working toward NCQA Recognition may apply for the PCMH PRIME program and NCQA PCMH recognition concurrently. 

This applies to the following Programs and Years:

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:

The PCMH PRIME Certification program launched on January 1, 2016.

This applies to the following Programs and Years:

First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME.

Once your practice has submitted the HPC application and is ready for next steps with NCQA, you should apply through the new NCQA Q-PASS system. The PCMH PRIME application is separate from the PCMH application in Q-PASS. Practices may apply for PCMH PRIME Certification separately or concurrently with the PCMH Recognition process and Annual Reporting.

• For PCMH 2011 (except Level 1) and PCMH 2014 Level 1 or 2 Recognized practices:
  • Practices planning to undergo the PCMH 2017 Recognition process in the near future are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact Government Recognition Initiative and Projects (GRIP) Staff at pcmh-grip@ncqa.org for more information.
  • Recognized practices not planning to renew their PCMH Recognition in the near future may apply for PCMH PRIME Certification separately, at any time.

§  For PCMH 2014 Level 3 or PCMH 2017 Recognized practices:

• Practices that are maintaining PCMH Recognition through the Annual Reporting process may apply for PCMH PRIME Certification concurrently or separately from the Annual Reporting process, whichever is most convenient for the practice.

• For Practices without PCMH Recognition:
  •  Practices must attain PCMH Recognition in order to be eligible for PCMH PRIME Certification. Such practices are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact GRIP Staff, pcmh-grip@ncqa.org, for more information.

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: