FAQ Directory: Health Plan Accreditation

NCQA Health Plan Accreditation is the most widely recognized, evidence-based program in the industry dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. It’s the only evaluation program that bases results on actual measurement of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures).

This applies to the following Programs and Years:

An organization is eligible for the NCQA Health Plan Medicaid Module if:

• Its Medicaid product line has a current NCQA Accreditation status as a First or Renewal Survey, or
• It is seeking accreditation for its Medicaid product line under NCQA HP Accreditation as an Interim, First or Renewal Survey.

This applies to the following Programs and Years:

NCQA LTSS Distinction for Health Plans is a complementary program designed to support health plans coordinating LTSS. The program standards provide a framework for organizations to deliver efficient, effective person-centered care that meets people’s needs, helps keep people in their preferred setting and aligns with state requirements.

This applies to the following Programs and Years:

Over 1,000 health plan products have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

This applies to the following Programs and Years:

Submit your request for the 2018 Medicaid Module at My NCQA.

This applies to the following Programs and Years:

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

This applies to the following Programs and Years:

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

This applies to the following Programs and Years:

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

This applies to the following Programs and Years:

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

This applies to the following Programs and Years:

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

This applies to the following Programs and Years:

An organization is eligible for the NCQA LTSS Distinction for a product/product line if:

• The product/product line has a current NCQA Accreditation status, or
• The product/product line is seeking NCQA Health Plan Accreditation.

Note:  NCQA conducts LTSS Distinction Surveys at the legal-entity level. Organizations undergoing Interim Survey are not eligible for LTSS distinction.

Health plans that coordinate LTSS and do not provide medical or behavioral services are not eligible for this distinction but can earn Accreditation of Case Management for LTSS.
 

This applies to the following Programs and Years:

• 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 help plans improve in areas of:
  • QI process.
  • Population health management.
  • Practitioner network and access to care.
  • Utilization management processes.
  • Credentialing and recredentialing processes.
  • Members’ rights and responsibilities.
  • Member connection.
  • Medicaid service requirements.
• Satisfy state requirements and employer needs. The standards align with many state requirements.

This applies to the following Programs and Years: