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. 

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