Credentialing Accreditation & Certification Programs

A QUALITY IMPROVEMENT FRAMEWORK

Credentialing is an essential safety component of the health care system. Organizations must establish the qualifications of their licensed medical professionals by assessing their background and legitimacy to provide care.

NCQA Credentialing programs focus on improving consumer protection and customer service. They provide a framework for implementing industry best practices that help organizations credential and recredential health care professionals accurately and effectively.

Understanding that not all standards apply to every organization’s credentialing needs, NCQA offers two different tailored program tracks.

• NCQA Credentialing Accreditation evaluates the operations of organizations providing full-scope credentialing services, which includes verifying practitioner credentials and credentialing/recredentialing committee review of practitioners.
• NCQA Credentialing Certification assesses organizations that verify practitioner credentials. Verification is accomplished through the primary source, a recognized source or a contracted agent of the primary source.