Case Management Accreditation assesses an organization’s performance in the following key areas:
- Identification and assessment
- Care planning
- Care monitoring
- Care transitions
- Measurement and quality improvement
CM 2014
FAQ Directory: Case Management
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8.20.2018 What are the Case Management Accreditation requirements?
8.20.2018 What is the process for earning Case Management 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.
CM 2014
8.20.2018 How do I get started?
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.
CM 2014
8.20.2018 Where can I find the Case Management Standards and Guidelines?
Find the Standards and Guidelines document in the NCQA eStore.
CM 2014
8.20.2018 What organizations are eligible for Case Management Accreditation?
Case Management Accreditation is for organizations that provide a broad range of case management services for complex and high-risk populations. Organizations are eligible if it:
- Provides case management services for at least 6 months.
- Delivers a broad range of case management services for complex or high-risk populations.
- Perform functions covered in the accreditation program or arrange for the functions to be performed, directly or through a service agreement.
Manage valid sample size of individuals for NCQA evaluation, where standards require patient file review.
CM 2014
8.20.2018 How long does it take to earn Case Management Accreditation?
8.20.2018 How does Case Management Accreditation help my organization?
Use the NCQA Case Management Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based best practices to ensure:
- Efficient and cost-effective case management processes and service delivery.
- Apply a QI process to improve operations.
- Maintain security of personal health information.
- Ensure patient access to well-qualified case management staff.
- Develop personalized, patient-centered care plans.
- Manage patients between care settings.
- Conduct systematic patient-centered assessments.
- Monitor patient to care goals progress.
CM 2013
8.20.2018 What is Case Management Accreditation?
NCQA Case Management Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the operations of case management programs in provider, payer or community-based organizations. NCQA-Accredited organizations demonstrate they have the internal processes and service delivery structure to cost-effectively meet the complex patient needs to improve health or functional capability.
CM 2013
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.
CM 2014
2.15.2017 Effective date for Case Management Accreditation 2017 and Termination date of Case Management Accreditation 2014 When will the 2017 CM standards be effective and when will the 2014 CM standards year end?
5.01.2015 Specific Regulatory Actions to be Reported What specific regulatory actions must be reported?
The organization must report the occurrence of any of the following actions by any federal or state regulatory authority:
- Issuance of Intermediate Sanctions and/or suspension of enrollment by CMS or any other federal or state regulatory authority.
- Issuance of any fine equal to or exceeding $50,000 related to Organization’s operations by CMS or any other federal or state regulatory authority.
- Issuance of any request for a corrective action by any federal or state regulatory authority where the substance of such corrective action relates to the Organization’s handling of utilization management decisions, network adequacy, benefit denials, complaints, grievances, appeals or other important patient safety matters.
The above actions are referred to as the “final determination” within the Agreement.
CM 2010
5.01.2015 Reporting Regulatory Actions Are health plans required to report regulatory actions taken against the organization?
Yes. The Agreement for Health Plan Accreditation Survey (the “Agreement”), specified in the “Organization’s obligations” section of the standards and guidelines, requires the organization to provide NCQA written notice within thirty (30) calendar days of the final determination by a state or federal agency with respect to request for corrective action, imposition of sanctions, changes in licensure or qualification status, if applicable, or violation of any federal or state law that affects the Scope of Review under the Standards and Guidelines. These are termed Reportable Events.
CM 2013