PCMH Pricing

NCQA PCMH Recognition pricing is based on a practice’s eligibility for single site pricing or multi-site pricing, and on the number of clinicians in the practice.

The following pricing goes into effect for PCMH Recognition on January 1, 2020.

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Pricing: Single Site

Single site pricing is for organizations with fewer than three sites seeking recognition, or for organizations with three or more sites that do not meet multi-sites criteria. Practices seeking recognition for the first time pay the initial recognition fee at enrollment. Thereafter, they pay the recognition fee at Annual Reporting. Fees apply to each clinician associated with the sites’s recognition.

 Number of CliniciansInitial Recognition FeeAnnual Reporting Fee
 1-2$800 $155
 3-12$475 $155
 13+$55 $15.50

 

Example: The example below will provide you some context as to how pricing is applied. For this example, an organization has 1 sites: a single practice site with 16 clinicians.

Initial Recognition Fee
Site ACost for clinicians
1-2 ($800 each)
Cost for clinicians
3-12 ($475 each)
Cost for clinicians
13+ ($55 each)
Total
16 clinicians$1,600$4,750$220$6,570

 The organization pays $6,200 for its Initial Recognition Fee.

Annual Reporting Fee
Site ACost for clinicians
1-12 ($155 each)
Cost for clinicians
13+ ($15.50 each)
Total
16 clinicians$1,860$62$1,922

The organization pays $1,922 each year during its annual reporting period.

Pricing: Multi-Site

Multi-sites pricing is for practices that:

  • Have three or more sites operating under the same legal organization;
  • Share an EHR system; AND
  • Have at least some of the same policies and procedures.

Sites seeking recognition for the first time pay the recognition fee at enrollment. Thereafter, they pay the recognition fee at their Annual Reporting.

Organizations that bring sites through the multi-entity process pay an organization multi-sites fee of $1,600 during initial recognition, as well as a per clinician fee for each sites. The organization multi-sites fee allows you to bring through as many sites as you want for one year at the multi-sites rate. If you wish to add new sites after that year time frame, you must pay a new multi-sites fee.

Sites seeking recognition for the first time pay the initial recognition fee at enrollment. Thereafter, they pay an Annual Reporting fee each year for their Annual Reporting period. Fees apply to each clinician associated with the sites’s recognition.

 

 Number of CliniciansInitial Recognition FeeAnnual Reporting Fee
 1-12$255
 $155
 13+$30 $15.50
 Plus Multi-Site Fee:
$1,600

 

Example: The example below will provide you some context as to how pricing is applied. For this example, an organization has 2 practice sites. Site A has 14 clinicians, Site B has 6 clinicians, Site C has 16 clinicians.

Initial Recognition Fee
EntityCost for clinicians
1-12 ($255 each)
Cost for clinicians
13+ ($30 each)
Total
Site A (14 clinicians)$3,060$60$3,120
Site B (6 clinicians)$1,530$1,530
Site C (16 clinicians)$3,060$120$3,180
Organization Multi-Site Fee$1,600
$9,430

 

The organization pays $9,430 for its Initial Recognition Fee.

Annual Reporting Fee
SiteCost for clinicians
1-12 ($155 each)
Cost for clinicians
13+ ($15.50 each)
Total
Site A (14 clinicians)$1,860$31$1,891
Site B (6 clinicians) $930$930
Site C (16 clinicians)$1,860$62$1,922
$4,473

The organization pays $4,473 each year during its Annual Reporting period.

Pricing: Extra Virtual Review

Sites that have not achieved recognition after the third check-in or have not completed recognition within the 12-month allotted time frame can purchase an extra Virtual Review. The pricing for the extra review is 50% of the initial per clinician fee paid by the entity. Fees apply to each clinician associated with the entity’s recognition.

 Number of Clinicians Extra Check-in Fee Single-Site per ClinicianExtra Check-in Fee Multi-Site per Clinician
 1-2$375$125
 3-12$225$125
13+$25$12.50

Refund Policy

NCQA will refund 80% of the Initial Recognition Fee paid by an entity if the practice cancels their application with NCQA within 45 calendar days of payment. After this time, there is no right to a refund. For refund requests submitted within 5 calendar days of payment, NCQA will refund the Initial Recognition fee in full.  All refund requests must be in writing and should be submitted via My NCQA. There is no right to a refund for any other fees or costs paid to NCQA.

Partners In Quality Discount Pricing

The Partners in Quality discount* is available for both single and multi-entity practices pursuing recognition for the first time. NCQA offers a discount to applicants sponsored by NCQA Partners in Quality (health plans, employers and other organizations that provide resources and services to support practices in pursuit of PCMH transformation).

Entities that use a Partner In Quality discount code receive 20% OFF their initial recognition fee.

To get this discount, request a discount code from your Partners in Quality sponsor organization and apply it when you pay during enrollment.

*Applies to initial recognition fees only.

Reconsideration


The fee for Reconsideration of a Recognition decision is $1,500. A practice that would like to initiate the Reconsideration process must pay this fee when it submits its written request.

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