Health Plan Accreditation
Health plans must support care that keeps members at optimum levels of health while also controlling costs and meeting government and purchaser requirements. NCQA Health Plan Accreditation helps plans meet these goals.
Coronavirus and Health Plan Accreditation
See the available telehealth accommodations and exceptions for NCQA Accreditation and Certification programs.
We are adapting policies in response to the COVID-19 pandemic. Learn more here.
A QUALITY IMPROVEMENT FRAMEWORK
NCQA Health Plan Accreditation builds upon more than 25 years of experience to provide a current, rigorous and comprehensive framework for essential quality improvement and measurement. It is the only program in the industry that bases results on clinical performance and consumer experience (HEDIS® and CAHPS®).
NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Standards evaluate plans on:
- Quality Management and Improvement.
- Population Health Management.
- Network Management.
- Utilization Management.
- Credentialing and Recredentialing.
- Members’ Rights and Responsibilities.
- Member Connections.
- Medicaid Benefits and Services.
The use of HEDIS data allows the Health Plan Accreditation to effectively measure care and service performance. This focuses attention on activities that keep members healthy.
Why Health Plan accreditation?
Improve operational efficiencies.
The standards provide a framework for implementing best practices to apply a QI process to improve key operational areas.
Satisfy state requirements and employer needs.
The standards align with many state requirements and highlight areas of importance to employers, including access to care and prevention services.
Keep patients happy and healthy.
The standards provide a framework for improving key impact areas: care coordination, access and member connections—availability of health resources such as wellness services and self-management tools for chronic disease management.
Demonstrate your commitment to quality.
NCQA is the most widely-recognized accreditation program in the United States.
Latest Health Plan Accreditation Blog Articles
NCQA offers several related programs for organizations eligible for Health Plan Accreditation. Each program helps organizations improve their operations and initiatives in targeted areas and demonstrate their commitment to quality.
Medicare Advantage Deeming
Health Plans that earn NCQA Medicare Advantage deeming are deemed for Medicare requirements for Special Needs Plan Model of Care requirements.
Long-Term Services and Supports Distinction
NCQA offers a Long-Term Services and Supports (LTSS) Distinction for organizations that provide managed health services and coordinate social services for LTSS.
The standards provide a framework for organizations to deliver effective person-centered care that meets people’s needs and aligns with state requirements.
Health Equity Accreditation Programs
Health Equity Accreditation Programs focus on the foundation of health equity work: building an internal culture that supports the organization’s external health equity work; collecting data that help the organization create and offer language services and provider networks mindful of individuals’ cultural and linguistic needs; identifying opportunities to reduce health inequities and improve care.
Health Plan Medicaid Module
The Health Plan Medicaid Module helps plans improve their opportunity to receive a streamlined state annual compliance review.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Quality and Research (AHRQ).
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