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.

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Pricing: Single Site

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

 Number of CliniciansInitial Recognition FeeAnnual Reporting Fee
 1-12$500 $120
 13+$50 $12

 

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

Initial Recognition Fee
Site ACost for clinicians
1-12 ($500 each)
Cost for clinicians
13+ ($50 each)
Total
16 clinicians$6,000$200$6,200

 

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

Annual Reporting Fee
Site ACost for clinicians
1-12 ($120 each)
Cost for clinicians
13+ ($12 each)
Total
16 clinicians$1,440$48$1,488

 

The organization pays $1,448 each year during its annual reporting period.

Pricing: Multi-Site

Multi-site pricing is for practices that:

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

Practices seeking recognition for the first time pay the recognition fee at enrollment. Thereafter, they pay the recognition fee at their annual check-in. Fees apply to each clinician in each practice that earns recognition.

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

 Number of CliniciansInitial Recognition FeeAnnual Reporting Fee
 1-12$250
 $120
 13+$25 $12

 

Example: The example below will provide you some context as to how pricing is applied. For this example, an organization has 3 practice sites. Site A has 14 clinicians, Site B has 6 clinicians, Site C has 16 clinicians.

Initial Recognition Fee
SiteCost for clinicians
1-12 ($250 each)
Cost for clinicians
13+ ($25 each)
Total
Site A (14 clinicians)$3,000$50$3,050
Site B (6 clinicians)$1,500$1,500
Site C (16 clinicians)$3,000$100$3,100
$7,650

 

The organization pays $7,650 for its Initial Recognition Fee.

Annual Reporting Fee
SiteCost for clinicians
1-12 ($120 each)
Cost for clinicians
13+ ($12 each)
Total
Site A (14 clinicians)$1,440$24$1,464
Site B (6 clinicians) $720$720
Site C (16 clinicians)$1,440$48$1,488
$3,672

The organization pays $3,672 each year during its annual reporting period.

Pricing: Extra Check-In

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

 Number of Clinicians Extra Check-in Fee Single-Site per ClinicianExtra Check-in Fee Multi-Site per Clinician
 1-12$250$125
13+$25$12.50

New Refund Policy

NCQA will refund 80% of the Initial Recognition Fee paid by a practice 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 https://my.ncqa.org/. There is no right to a refund for any other fees or costs paid to NCQA. This policy is in effect as of 9/1/2018.

Partners In Quality Discount Pricing

The Partners in Quality discount* is now available for both single and multi-site 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).

Practices 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.

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