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.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Print this page.
Print this page.
The program is open to practices in Massachusetts currently recognized as:
A practice that is working toward NCQA Recognition may apply for the PCMH PRIME program and NCQA PCMH recognition concurrently.
There are a variety of validated screening tools that practices may use to meet PP 07-PP 11.These include, but are not limited to, PHQ-9, AUDIT, GAD-7, CRAFFT, and SWYC. The PCMH PRIME Standards and Guidelines document gives additional examples of screening tools that may be used to fulfill each factor. Practices may select from among those examples, or use any other validated screening tools that work for them.
If your practice has additional questions about PCMH PRIME, you can:
PCMH PRIME is a site-specific certification program. Unless otherwise noted in the PCMH PRIME Standards and Guidelines, practices must submit site-specific evidence. For some of the PCMH PRIME criteria, practices that are part of a multi-site organization can share the same evidence. Please see the PCMH PRIME Standards and Guidelines for specific details regarding which evidence can be shared across practice sites.
No. The PCMH PRIME Certification program is limited to practices in Massachusetts. Practices outside of Massachusetts offering integrated behavioral health services are encouraged to apply to NCQA’s Distinction in Behavioral Health Integration, which is available nationally.
As practices obtain PCMH PRIME Certification, or make a commitment to doing so (thereby receiving “Pathway to PCMH PRIME” status), their names are posted on this website.
No. Care managers must be able to serve any patient within a practice, not just patients from specific payers. The aim of PCMH PRIME Certification is to encourage coordinated, team-based care for all patients, regardless of payer status. To that end, criterion PP 01 can only be satisfied through use of care managers whose services are made available to patients based on need and not payer type.
The PCMH PRIME program standards do not define care manager qualifications; this requirement was intentionally left flexible so that practices could fulfill PP 01 with a care manager that best suits the practice’s patient population needs.
Generally, a care manager must facilitate appropriate behavioral healthcare services by applying specialized knowledge and judgment to support and address behavioral health needs. The practice must define the qualifications and/or training a care manager must have in order to manage patients’ behavioral health conditions. The practice must also demonstrate that at least one member of the staff with care management responsibilities has the necessary qualifications/training to support patients with behavioral health needs.
