Credentialing Accreditation Requirements
NCQA Credentialing Accreditation evaluates organizations providing full-scope credentialing services. Your organization must meet eligibility criteria to pursue accreditation.
FOCUS AREAS TO ENSURE HIGH QUALITY
NCQA Credentialing Accreditation is designed to ensure that organizations can maintain a high-quality network for members and contracted clients. Requirements cover these key areas:
- An internal QI process.
- Ensuring appropriate agreements and collaboration with clients.
- Protecting credentialing information.
- A peer-review process.
- Credential verification.
- Monitoring of sanctions and complaints.
To see all program requirements, get the Standards & Guidelines document.
REQUIRED ORGANIZATION SERVICES
The standards are designed for organizations that provide full-scope credentialing services, including:
- Verification of practitioner credentials through a primary source, through a recognized source or through a contracted agent of the primary source.
- A designated credentialing committee that reviews practitioner credentials and makes credentialing recommendations.
- Monitoring practitioner sanctions, complaints and quality issues between recredentialing cycles.
IS MY ORGANIZATION ELIGIBILE?
Organizations eligible for Credentialing Accreditation:
- Must not be licensed as an HMO, POS, PPO or EPO.
- Must not be eligible for NCQA Accreditation as a health plan or an MBHO.
- Must perform credentialing functions directly or through a contractual agreement.
- Must perform credentialing activities for at least 50% of the practitioner network.
Note: A “practitioner network” is the practitioner network of clients and organizations.