Health Plan Accreditation Benefits & Support

HOW DOES MY ORGANIZATION BENEFIT?

• Use the NCQA Health Plan Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based best practices to help plans improve in areas of:
  • Quality improvement process.
  • Population health management.
  • Practitioner network and access to care.
  • Utilization management processes.
  • Credentialing and recredentialing processes.
  • Members’ rights and responsibilities.
  • Medicaid service requirements.

• Satisfy state requirements and employer needs. The standards align with many state requirements.
• Keep patients happy and healthy. The standards provide a framework for improving key impact areas.
• Demonstrate your commitment to quality.

NCQA ACCREDITED PLANS PERFORM BETTER

NCQA Accreditation is widely used and respected because it gets results. Based on health plan ratings on key HEDIS^® measures, NCQA-Accredited Medicare Advantage and Medicaid plans perform better in areas of treatment and prevention than non-Accredited plans.

WHERE CAN I FIND RESOURCES?

You can find more information about Health Plan Accreditation in the following:

• Standards and Guidelines: Provides the complete descriptions of the standards, including the intent and scope of the review.
• Interactive Review Tool: Includes the complete standards and guidelines and allows your organization to determine its readiness for a survey.

ADDITIONAL SUPPORT

• The Policy Clarification Support (PCS) system, My NCQA and FAQs can help you interpret NCQA standards.
• Policy Updates: Lists corrections, clarifications and policy changes to our stated Standards and Guidelines.
• HEDIS Users Group: An interactive and informative community for those working with HEDIS to receive the most up-to-date information.
• Education and Training: NCQA offers a variety of training options, from on-demand web-based programs to live, in-person seminars.
• Advertising Guidelines: Designed to help customers create clear, factual and accurate advertising and marketing materials.
• Seals: Created to provide print-friendly graphics for use in promoting the NCQA status.