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
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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.
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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.
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Find the Standards and Guidelines document in the NCQA eStore.
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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:
Manage valid sample size of individuals for NCQA evaluation, where standards require patient file review.
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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:
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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.
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More than forty organizations have earned NCQA Credentialing Accreditation. See the NCQA Report Card for a directory of accredited organizations.
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The organization must report the occurrence of any of the following actions by any federal or state regulatory authority:
The above actions are referred to as the “final determination” within the Agreement.
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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.
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